My four-year-old, who has no known history of diabetes, had an A1c of 5.7 based on the adult scale of 4.5 to 6.0. To my understanding, that would mean her glucose levels have averaged between 100 mg/dl [5.6 mmol/L] to 135 mg/dl [7.5 mmol/L] in the past 90 days. A normal glucose for a child of her age is 60 mg/dl [3.3 mmol/L] to 100 mg/dl [5.6 mmol/L]. Does the A1c result of 5.7 indicate that she is pre-diabetic or diabetic?

I would not be concerned about a “high normal” A1c in an otherwise normal child, (even if the child has a strong family history of type 1 diabetes. The precision (often expressed as the coefficient of variation) of the A1c value and the reference range can depend on the assay being used (for example, the DCA 2000 versus a home A1c kit) and also within an individual since it can be affected by small differences in hemoglobin types. Also, in children, stress and/or illness can sometimes elevate blood sugars transiently, without diabetes arising later.

If you have a family history of type 1 diabetes and are interested in getting your child screened with antibodies, I would check and see if your child is eligible for any open protocols through TrialNet as a first step.

LAD