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COMMENT: Dichotomizing a continuous variable is always dicey. The trouble with these sorts of analyses is that A1C is just one risk factor and I find it hard to see what changes in recommendations that I would make at an A1C of 5.7% to 6.4% that I would not make absent knowledge of the A1C: lose weight if the BMI is >25, increase physical activity, diagnose and treat other cardiovascular risk factors, hypertension and abnormal lipids. I guess what the knowledge of A1C adds is the probability of developing type 2 diabetes as the higher the A1C in the "normal" range the more likely is the development of type 2 diabetes. in terms of adding metformin, the data on the benefit of adding metformin when lifestyle chages are not successful is based upon glucose values, not A1C. I am curious as to what you use to diagnose pre-diabetes glucose or A1C, what values you use and your use of metformin in pre-diabetes.