New Delhi: The generally used HbA1c blood test for diagnosing and monitoring diabetes may give deceptive outcomes in tens of millions of individuals throughout South Asia, significantly in India, as a result of excessive prevalence of anaemia and inherited blood issues, a brand new evaluation revealed in Lancet Regional Well being – Southeast Asia has warned.
The evaluate, led by senior endocrinologist Prof Anoop Misra, highlights that HbA1c ranges—which replicate common blood glucose by measuring glycation of haemoglobin—can both under- or overestimate true blood sugar ranges in people with situations affecting pink blood cells, together with iron deficiency anaemia, haemoglobinopathies and glucose-6-phosphate dehydrogenase (G6PD) deficiency.
“In areas like India, the place dietary anaemia and pink blood cell issues are widespread, unique reliance on HbA1c may result in misclassification of diabetes standing,” Prof Misra, Chairman of Fortis C-DOC Heart of Excellence for Diabetes, mentioned.
The authors be aware that greater than half the inhabitants in sure components of India is affected by iron deficiency anaemia, which might distort HbA1c readings and complicate each diagnosis and long-term monitoring of diabetes. The evaluate additionally cautions that undetected G6PD deficiency in males might delay diabetes diagnosis by as much as 4 years, probably growing the chance of problems.Shashank R Joshi, endocrinologist at Joshi Clinic, Mumbai, mentioned HbA1c variability may be noticed even in well-equipped city hospitals on account of pink blood cell abnormalities. “In rural and tribal areas, the place anaemia and inherited blood issues are extra widespread, discrepancies may be even larger,” he mentioned.
The authors additional level out that inconsistent laboratory high quality management throughout areas can add to inaccuracies, making interpretation of HbA1c outcomes difficult. Public well being surveys that rely solely on HbA1c may subsequently underestimate or misrepresent India’s true diabetes burden, the research mentioned.
The evaluate recommends a resource-adapted strategy to diabetes diagnosis and monitoring. In low-resource settings, it suggests using oral glucose tolerance checks (OGTT) for diagnosis together with periodic self-monitoring of blood glucose and primary haematological screening. In tertiary care centres, a mixture of HbA1c, OGTT, steady glucose monitoring and different biomarkers equivalent to fructosamine is suggested.
Dr Shambho Samrat Samajdar, a co-author from Kolkata, mentioned combining glucose-based checks with haematological assessments supplies a extra correct image of diabetes danger and will assist refine public well being estimates and useful resource allocation.
The authors conclude that in nations the place anaemia and blood issues are endemic, HbA1c shouldn’t be used in isolation however alongside complementary checks for efficient diabetes diagnosis and administration.
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