NewKerala.com

HbA1c Test Alone Can Misdiagnose Diabetes in India, Experts Warn

A Lancet study review indicates the HbA1c test, widely used in India, may not accurately reflect blood glucose levels for millions, especially where anemia and blood disorders are common. Experts, including V Mohan, emphasize that HbA1c should not be used as a sole diagnostic tool, as it can misclassify diabetes status and double the perceived prevalence. Conditions affecting hemoglobin's quantity or lifespan can distort HbA1c values, leading to late diagnoses or misdiagnoses. The consensus is that traditional glucose testing remains the most reliable method for diagnosing diabetes in the Indian population.

Key Points: HbA1c Not a Single Diabetes Test in India, Say Experts

  • HbA1c alone can delay or misdiagnose diabetes
  • Conditions like anemia distort HbA1c accuracy
  • Glucose test remains gold standard for diagnosis
  • Rural areas face greater discrepancy risks
2 min read

Glucose remains best test for diabetes diagnosis; HbA1c cannot be used as single test, says top expert

Top experts warn against using HbA1c alone for diabetes diagnosis in India due to anemia and blood disorders, advocating for glucose tests.

"Glucose still remains as the best test for diagnosis... - V Mohan"

By Shalini Bhardwaj, New Delhi, February 11

On the Lancet study claiming that the HbA1c alone could delay diagnosis of diabetes, Chairman, Mohan's Diabetes Specialities Centre, V Mohan said, "This article is a review article... It 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..."

" 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

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.

"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."

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

Share this article:

Reader Comments

R
Rohit P
Very true. Many labs in smaller towns are not equipped for accurate HbA1c testing. My uncle was told he was diabetic based on HbA1c, but a second opinion with fasting glucose showed he was borderline. The stress it caused the family was unnecessary. Stick to the gold standard.
A
Ananya R
As someone with a family history of thalassemia, this article is a relief. I've always wondered if my HbA1c was accurate. Doctors should definitely consider the full picture, especially for us in South Asia where blood disorders are common. Good research!
D
David E
While I respect the experts, I hope this doesn't create confusion. HbA1c is very convenient for monitoring. The key takeaway should be to use it alongside glucose tests, not to abandon it. Context matters.
S
Shashank Joshi
The point about rural and tribal areas is critical. We need better diagnostic protocols that are accessible and accurate for everyone, not just urban hospitals. Public health policy must adapt.
K
Kavya N
Thank you for this article! So many people are getting unnecessary labels. My advice: always get a second test if diagnosed with just HbA1c. Better safe than sorry, especially with lifestyle diseases on the rise in India.

We welcome thoughtful discussions from our readers. Please keep comments respectful and on-topic.

Leave a Comment

Minimum 50 characters 0/50