Rising diabetes Burden

- diabetes cases are increasing rapidly across the world, especially in India.

- HbA1c is widely used as the primary test for diagnosing and monitoring diabetes.

- A new study published in The Lancet Regional health – Southeast Asia raises concerns about its reliability in indian populations.

- Researchers warn that depending only on HbA1c may lead to missed or delayed diagnosis in many people.

What HbA1c Measures

- HbA1c reflects average blood sugar levels over the past 2–3 months.

- It measures how much glucose is attached to hemoglobin in red blood cells.

- Standard interpretation:

  - Below 5.7% — Normal

  - 5.7–6.4% — Prediabetes

  - 6.5% or above — Diabetes

- It is commonly considered a “gold standard” test globally.

Why Accuracy Is Questioned

- HbA1c depends completely on hemoglobin quantity and quality.

- If hemoglobin levels or red blood cell lifespan change, results can be distorted.

- Conditions that affect results include:

  - iron deficiency anemia

  - hemoglobin genetic disorders

  - G6PD enzyme deficiency

  - Other blood-related diseases

- These conditions are common in India, making HbA1c less reliable for many.

India-Specific Risk Factors

- Large segments of the indian population suffer from anemia and iron deficiency.

- In some regions, over 50% of people are iron-deficient.

- Rural and tribal populations are more severely affected.

- Even urban hospital patients show red blood cell abnormalities.

- In men with G6PD deficiency, diabetes diagnosis may be delayed by up to four years.

Expert Observations

- Study led by Prof. Anoop Mishra of Fortis C-Doc Centre of Excellence for Diabetes.

- Researchers state HbA1c alone should not guide diagnosis in high-anemia populations.

- Misleading results can cause both underdiagnosis and misdiagnosis.

- Incorrect readings increase long-term complication risks.

Recommended Testing Approach

- Experts advise combining HbA1c with other diagnostic methods.

- Suggested additional tests include:

  - Fasting blood glucose

  - Oral glucose tolerance test (OGTT)

  - Regular blood sugar monitoring

  - Basic blood tests for anemia

- In selected cases:

  - Continuous Glucose Monitoring (CGM)

  - Fructosamine testing

- Personalized testing strategies are essential for accurate diabetes diagnosis in India.

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