In short
- A normal HbA1c is below 5.7%. From 5.7% to 6.4% is prediabetes, and 6.5% or more is in the diabetes range.
- With diabetes, many adults aim for below 7%. Your own target may be lower or higher, and that is something to settle with your doctor.
- You don't need to fast for it. It reflects roughly the last two to three months, with the most recent weeks counting most.
- Anaemia, thalassaemia trait, pregnancy, kidney failure or a recent blood transfusion can make the number misleading.
Where does your HbA1c fall?
Prediabetes
From 5.7% to 6.4% is prediabetes, and 6.5% or more is in the diabetes range.
This reads one result; it is not a diagnosis. Diagnosing diabetes usually needs a second abnormal result — read on below.
On this page
What HbA1c actually measures
Sugar in your blood sticks to haemoglobin, the protein inside red blood cells. The higher your sugar runs, the more of it sticks. HbA1c is simply the percentage of haemoglobin that has sugar attached.
A red blood cell lives for about three months, so the test gives you an average over roughly that period. It isn't a snapshot like a glucometer reading. One heavy wedding dinner last night won't move it much. A month of high readings will.
Normal, prediabetes and diabetes
| Result | HbA1c (%) | HbA1c (mmol/mol) |
|---|---|---|
| Normal | Below 5.7% | Below 39 |
| Prediabetes | 5.7–6.4% | 39–47 |
| Diabetes range | 6.5% or more | 48 or more |
One result of 6.5% or more is not a diagnosis by itself. Unless your sugar is obviously very high and you have symptoms, the ADA asks for a second abnormal result to confirm it: a repeat HbA1c, or a different test such as fasting sugar.
For a diagnosis, the test should be done with a standardised, certified laboratory method. If a result surprises you, repeating it at a well-established lab is reasonable before anything else.
Your HbA1c as an average sugar
Doctors sometimes translate HbA1c into an estimated average glucose, in the same units as your glucometer. The conversion comes from a large international study called ADAG.
| HbA1c | Average glucose (mg/dL) | Average glucose (mmol/L) |
|---|---|---|
| 6% | 126 | 7.0 |
| 7% | 154 | 8.6 |
| 8% | 183 | 10.2 |
| 9% | 212 | 11.8 |
| 10% | 240 | 13.4 |
It is only an average
Two people with an HbA1c of 7% can have very different days. One stays steady from morning to night. The other swings between 300 and 50. HbA1c can't tell these apart, which is why your glucometer or sensor readings still matter even when the report looks good.
Your target if you have diabetes
For many adults with diabetes who aren't having serious lows, the ADA's 2026 goal is an HbA1c below 7% (53 mmol/mol). But the right target is the lowest one you can reach safely. Chasing a perfect number at the cost of fainting at work is a bad trade.
- Lower, around 6.5%, can suit someone younger and otherwise healthy, if it can be reached without lows.
- Higher, up to about 8%, is often wiser for older people, people with other serious illnesses, or anyone who has had a severe low.
- In pregnancy the targets are stricter, and your doctor will set them.
How often to test
The ADA recommends checking at least twice a year. If you're at your target and stable, twice a year is usually enough. If your treatment has just changed, or you haven't reached your target yet, test about every three months, because that is how long the number takes to fully show a change.
Testing every month adds little. Most of the change simply hasn't shown up yet.
When HbA1c can mislead
HbA1c assumes your red blood cells live a normal lifespan. Anything that changes that can push the number up or down, even when your actual sugar hasn't changed. If your HbA1c doesn't match your glucometer or sensor readings, tell your doctor.
- Iron-deficiency anaemia, which is common here, can make HbA1c read higher than it should.
- Blood loss, breakdown of red cells or a recent blood transfusion can make it read lower.
- Thalassaemia trait and other haemoglobin variants, both common in Pakistan, can affect the result or the lab method.
- Pregnancy, kidney failure and erythropoietin injections for anaemia all change how long red cells survive.
Bringing a high HbA1c down
Nothing lowers HbA1c in a week, because it reflects months. What brings it down is steady change: taking your medicines as prescribed, cutting back on sweet drinks and large portions of rice, roti and mithai, walking most days, and coming back for follow-up so your treatment can be adjusted.
Even a 1% drop is worth having. Every step down lowers the risk of damage to the eyes, kidneys and nerves.
Common questions
Do I need to fast for an HbA1c test?
No. You can eat and drink normally beforehand. If your doctor has asked for fasting sugar or cholesterol from the same blood sample, fast for those.
My HbA1c is 6.0%. Do I have diabetes?
No. 6.0% is in the prediabetes range (5.7–6.4%). It means your risk of diabetes is raised. Losing some weight if you're overweight and being active every day can bring it back toward normal, and it's worth re-checking within a year.
Is HbA1c better than fasting sugar?
Neither is simply better. HbA1c shows the longer picture and needs no fasting. Fasting sugar shows one morning. They don't always agree, and doctors often use both.
My HbA1c and my glucometer readings don't match. Which one is right?
Possibly both. Glucometer readings miss the hours you don't test, often after meals and overnight. But anaemia, thalassaemia trait and the other conditions above can also throw HbA1c off. Bring your readings and the lab report to your doctor.
Can HbA1c be too low?
If you're on insulin, or tablets such as gliclazide or glimepiride, a very low HbA1c can be a sign of frequent low sugars. Tell your doctor if you're getting lows.
About the author
Dr. Farrukh Javaid
- MBBS — University of Health Sciences, Lahore (2012)
- Postgraduate Diabetes Certification — BMJ & AKU, endorsed by RCP London (2023)
- Five years of endocrinology training — Services Hospital, Lahore
- Two years as diabetologist — Dilawar Hussain Foundation
- MPH in progress — University of Lahore
Sources
- American Diabetes Association Professional Practice Committee. 2. Diagnosis and classification of diabetes: Standards of Care in Diabetes—2026. Diabetes Care 2026;49(Suppl 1):S27–S49. doi.org/10.2337/dc26-S002
- American Diabetes Association Professional Practice Committee. 6. Glycemic goals, hypoglycemia, and hyperglycemic crises: Standards of Care in Diabetes—2026. Diabetes Care 2026;49(Suppl 1):S132–S149. doi.org/10.2337/dc26-S006
- Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ. Translating the A1C assay into estimated average glucose values. Diabetes Care 2008;31:1473–1478. doi.org/10.2337/dc08-0545
