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New Delhi: For years, HbA1c has been considered a reliable method for diagnosing diabetes or estimating one's progress in blood sugar management. However, recent studies and evidence suggest that relying solely on this one marker may not be the wisest approach, especially now that India has been termed the diabetes capital of the world. As per a recent academic exchange, using HbA1c numbers alone to determine diabetes risk or prevalence may not be good enough. The study appeared in The Lancet and has left many concerned.
Researchers point out that even authors of large national studies now acknowledge, albeit briefly, that HbA1c-only diagnosis has limitations. The concern is that these limitations are not marginal—they are structural, widespread, and deeply rooted in the region’s health profile.
HbA1c reflects average blood sugar levels over the past two to three months, but it is not immune to distortion. Conditions such as anaemia, pregnancy, recent blood transfusions, advancing age, haemoglobin disorders, haemolytic anaemia, and chronic kidney or liver disease can all skew HbA1c readings. In several cases, these factors artificially reduce HbA1c values, thereby concealing the current state of health and leading to misdiagnosis.
Anaemia, in particular, poses a major challenge in South Asia. Large pooled analyses indicate that nearly 45% of the population is affected, with prevalence climbing to almost 48% among women, older adults above 50 years, and even among people who already have type 2 diabetes. In such a context, interpreting HbA1c without accounting for haemoglobin levels becomes scientifically unsound. Experts stress that at the very least, haemoglobin measurements should be taken into account while getting an HbA1c test done. This should also include ferritin and iron levels.
A recent UK study, however, adds another layer to the debate. The debate highlights glucose-6-phosphate dehydrogenase (G6PD) deficiency, a genetic condition prevalent among South Asians. The study noted that undiagnosed G6PD deficiency can falsify HbA1c values, thereby delaying type-2 diabetes diagnosis by four years. As a result, most diabetics develop microvascular complications despite showing normal glucose levels.
Collectively, these raise the question of whether this global reliance on HbA1c for diabetes detection is wise, particularly in countries like India with diverse populations. National diabetes statistics influence screening, and researchers have warned that basing India's diabetes burden on HbA1c alone could be a methodological weakness, which could dilute timely detection and management norms.
As India grapples with a rising diabetes burden, it is imperative to move towards a more nuanced diagnostic approach that can help ensure a longer, healthier, and disease-free life.
