An A1C of 5.7% to 6.4% is prediabetes [1]. That result does not care what your weight looks like or what you expected to see. If you just got that number and your BMI seemed fine, you are not an exception to the rule. You are exactly who screening guidelines were built to catch, especially if you have South Asian ancestry. This page explains what prediabetes actually is, why the thresholds that trigger testing sit lower for Asian ancestry, and what the numbers say about what happens next.

What is prediabetes, exactly

Prediabetes is blood glucose higher than normal but not high enough for a type 2 diabetes diagnosis [2]. The American Diabetes Association sets the line: an A1C of 5.7% to 6.4% is prediabetes, and an A1C of 6.5% or higher is diabetes [1]. The A1C test measures your average blood glucose over the past 3 months, so a single result sits inside a window, not a moment.

Insulin resistance is the condition that usually sits underneath prediabetes. It means your body does not respond to insulin the way it should [2]. Most people with insulin resistance have no symptoms [2], and many people have it before their blood glucose ever rises high enough to show up as prediabetes on a test.

About 115 million US adults have prediabetes [3]. Most of them do not know it, because there are usually no signs [3]. You found out because someone ordered a test. That test is the only way to know.

Why screening thresholds are lower for Asian ancestry

The American Diabetes Association recommends testing for prediabetes in adults with a BMI of 25 or higher, or 23 or higher if they have Asian ancestry, who also have one or more additional risk factors [1]. That lower threshold exists because the data show diabetes risk rises at lower weights in people of Asian ancestry.

In the MASALA and MESA studies, US South Asian adults aged 44 to 84 had an age-adjusted type 2 diabetes prevalence of 23%, compared with 6% in white adults, 18% in African American adults, 17% in Latino adults, and 13% in Chinese American adults [4]. In Ontario, Canada, Chiu and colleagues followed 59,824 adults without diabetes and found a hazard ratio of 3.40 for developing diabetes among South Asian adults compared with white adults [5]. In that same cohort, the BMI carrying the same diabetes incidence rate as a BMI of 30 in white adults was a BMI of 24 in South Asian adults [5]. These are Canadian data, not US data, but they document the same pattern: diabetes risk appears at lower weights.

Flowers and colleagues added body composition measures to the MASALA and MESA analyses and concluded they did not identify strong evidence that accounting for body composition explains differences in the risk for type 2 diabetes [6]. That means the elevated risk is not simply about how much muscle versus fat someone carries. Something else is happening.

The WHO expert consultation on appropriate BMI for Asian populations identified potential public health action points at BMI values of 23.0, 27.5, 32.5 and 37.5 along the BMI continuum for Asian populations, and stated that the proportion of Asian people at high risk of type 2 diabetes and cardiovascular disease is substantial at BMI values lower than the existing WHO cut-off point for overweight of 25 or higher [7]. A normal weight by one standard is a risk threshold by another.

What the additional risk factors are

The American Diabetes Association lists these additional risk factors that, combined with a BMI of 23 or higher for Asian ancestry, trigger screening: a first-degree relative with diabetes, high-risk race, ethnicity and ancestry (the examples given are African American, Latino, Native American and Asian American), a history of cardiovascular disease, hypertension, abnormal cholesterol or triglyceride levels, polycystic ovary syndrome, and physical inactivity [1].

If you have a family history of diabetes, that is information. If you have a BMI of 23 and a prediabetes result, that is also information. Neither one writes your future. Both belong in the conversation with your clinician about what to do next.

What happens in the 5 to 10 year window

People with prediabetes have a high chance of developing type 2 diabetes within 5 to 10 years [2]. That is a timeline for a population. It is not a sentence. It is a window in which something can change.

In the Diabetes Prevention Program, a trial that tested lifestyle intervention, losing 5% to 7% of body weight lowered the chance of developing type 2 diabetes [2]. That is what the trial measured. It is not a promise that weight loss will prevent diabetes in any one person. It is not the only factor that matters. It is what one trial found when people changed their behavior and stuck with it.

The American Diabetes Association notes that at the present time there are no medications approved by the US Food and Drug Administration specifically for the prevention of type 2 diabetes [1]. The tools that exist are the ones you control: movement, food, sleep, stress, and the conversation with your clinician about what matters most to you.

What to do next

  1. Write down your A1C result and the date of the test before your next appointment.
  2. Ask your clinician what your result means for you specifically, given your family history, your weight, your other health conditions, and your own goals.
  3. Ask whether you qualify for a diabetes prevention program, which Medicare covers for people with a BMI above 23 if they self-identify as Asian [1].
  4. If you have a first-degree relative with type 2 diabetes, ask them when they were diagnosed and what their early symptoms were, if any. That conversation is not about your future. It is about what to watch for.
  5. Ask your clinician about the specific changes that matter most for you: movement, food choices, sleep, or something else.
  6. Get a copy of your test result in writing, and schedule a follow-up A1C test with your clinician to see whether the result changes.
  7. Visit the Sehat guides for more on what an A1C of 5.7% means and what actually changes diabetes risk.

Sources

  1. American Diabetes Association, Diagnosis and Classification of Diabetes, Standards of Care in Diabetes 2026, A1C cut points and screening thresholds, accessed 2026-08-06, https://diabetesjournals.org/care/article/49/Supplement_1/S27/163926/2-Diagnosis-and-Classification-of-Diabetes
  2. NIDDK, insulin resistance and prediabetes, definitions and the Diabetes Prevention Program result, accessed 2026-08-06, https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
  3. CDC, preventing type 2 diabetes, prevalence and absence of symptoms, accessed 2026-08-06, https://www.cdc.gov/diabetes/prevention-type-2/index.html
  4. Kanaya and colleagues, MASALA and MESA diabetes prevalence, South Asian and comparison group prevalence in US adults, accessed 2026-08-06, https://pubmed.ncbi.nlm.nih.gov/24705613/
  5. Chiu and colleagues, ethnic-specific BMI cutoff points, hazard ratio and BMI equivalence in Ontario Canada, accessed 2026-08-06, https://pubmed.ncbi.nlm.nih.gov/21680722/
  6. Flowers and colleagues, body composition and diabetes risk in South Asians, body composition analysis in MASALA and MESA, accessed 2026-08-06, https://pubmed.ncbi.nlm.nih.gov/30796111/
  7. WHO expert consultation, appropriate body-mass index for Asian populations, action points and cardiovascular risk, accessed 2026-08-06, https://pubmed.ncbi.nlm.nih.gov/14726171/