HbA1c test alone could delay diabetes diagnosis in India: Experts

A Lancet study warns that the HbA1c test, when used alone, is unreliable for diagnosing diabetes in India. Experts state glucose tests are superior as HbA1c can be distorted by common conditions like anaemia, leading to misdiagnosis.

On the Lancet study claiming that the HbA1c (glycated haemoglobin) alone could delay diagnosis of diabetes, Chairman, Mohan's Diabetes Specialities Centre, V Mohan said, "This article is a review article... It (HbA1c) is the gold standard for assessing long-term control of diabetes, but it is not the gold standard for diagnosing diabetes. Glucose still remains as the best test for diagnosis..."

Limitations of HbA1c for Diagnosis

" In India, the labs are not ready (to test HbA1c)... HbA1c cannot be used as a single test... We showed in our studies that using HbA1c doubles the prevalence of diabetes... Do not use the HbA1c alone for diagnosis. The test picks up people with very mild abnormalities and labels them as having diabetes..." He said

Lancet Viewpoint on Test Inaccuracies

According to a new evidence-based Viewpoint published online in Lancet Regional Health Southeast Asia, the widely used glycated haemoglobin (HbA1c) test, as available in India, may not accurately reflect blood glucose levels for millions of Indians, particularly in regions with high prevalence of anaemia, hemoglobinopathies, and red blood cell enzyme (G6PD) deficiency. Experts reviewed the reliance on HbA1c as a sole diagnostic or monitoring tool for type 2 diabetes in South Asia.

HbA1c measurements primarily reflect the glycation of haemoglobin. Any condition that affects the quantity, structure, or lifespan of haemoglobin--such as anaemia, hemoglobinopathies, or other red blood cell disorders--can distort HbA1c values and lead to misleading estimates of average blood glucose.

Risk of Misclassification

"Relying exclusively on HbA1c can result in misclassification of diabetes status," said Professor Anoop Misra, corresponding author and Chairman of Fortis C-DOC Centre of Excellence for Diabetes. "Some individuals may be diagnosed later than appropriate, while others could be misdiagnosed, which may affect timely diagnosis and management. Similarly, monitoring of blood sugar status may be compromised."

Regional Disparities in Testing

Shashank Joshi, co-author from Joshi Clinic, Mumbai, added, "Even in well-resourced urban hospitals, HbA1c readings can be influenced by red blood cell variations and inherited haemoglobin disorders. In rural and tribal areas, where anaemia and red cell abnormalities are common, the discrepancies may be greater." (ANI)

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