DEAR DR. ROACH: I am a healthy 63-year-old woman. I walk or ride the elliptical four to five times a week for 30 to 40 minutes, and I also strength train at the gym three times a week. I eat most of my meals at home and eat mostly healthy: daily salads, fruit, fish and chicken. Although I go out to eat on the weekends and enjoy a few snacks, I maintain a 30 pound weight loss since 2018 and I weigh 149 pounds at 5 feet 7 inches.

In November 2022, my A1C was 5.7% and my glucose level was 124 mg/dL (even though I hadn’t fasted for these tests). My endocrinologist was very concerned about prediabetes. Over the next few months, I was very rigid about my diet and my HbA1c level recently varied from 5.3% to 5.8%. I really can’t maintain the rigid diet that has dropped my HbA1c to 5.3%, but I still eat healthy.

I have an appointment with my endocrinologist next week and I know he will suggest medications based on our previous conversations. My questions are: Should I start taking medication to lower my HbA1c level? Is my body being damaged by a slightly elevated HbA1c level? If I wait and monitor my HbA1c level, at what level should I start treatment? All my other tests are normal and my cholesterol level is excellent. –DP

ANSWER: Prediabetes is most commonly defined as an HbA1c between 5.7% and 6.4%, so you are still in the prediabetes range, despite what appears to be an excellent diet and program of exercise. I advise my patients not to feel guilty about not being able to keep their blood sugar levels in the perfect range; it’s just not possible for some people.

Your endocrinologist’s goal will be to prevent you from developing diabetes, which is most commonly diagnosed by an HbA1c level of 6.5% or higher on two occasions. Although medications are sometimes used to achieve this, a healthy diet and regular physical activity have been shown to be more effective than medications. Of course, a combination of a careful, ongoing diet (that you can maintain) and regular physical activity would be more effective than either alone.

The decision to take medication is yours. If your HbA1C level is 5.8%, it’s likely minimal. The most common A1C goal for a healthy 63-year-old with diabetes is 7.0%, and you are well below that goal.