Lancet Regional Health – Southeast Asia Study Warns Standard Diabetes Test May Mislead Diagnosis & Monitoring in South Asian Populations

News Desk, News Nation 360 : The popular glycated haemoglobin (HbA1c) test, which is available in India, may not accurately reflect blood glucose levels for millions of Indians, especially in areas with high prevalences of anaemia, hemoglobinopathies, and red blood cell enzyme (G6PD) deficiency, according to a new evidence-based viewpoint that was published online in Lancet Regional Health: Southeast Asia. The review, headed by Professor Anoop Misra and associates, challenges the use of HbA1c as the exclusive method of diagnosing or tracking type 2 diabetes in South Asia. The main indicator of haemoglobin glycation is the HbA1c measurement. HbA1c levels can be distorted and provide inaccurate estimates of average blood glucose by any condition that alters the amount, composition, or lifespan of haemoglobin, such as anaemia, hemoglobinopathies, or other conditions affecting red blood cells. A recent review points out that, although HbA1c is a “gold standard” for diabetes management, it can provide erroneous data in populations with high prevalence of anaemia, G6PD deficiency, or hemoglobinopathies. In India, where more than 50% of the population in certain areas are iron-deficient, these factors can provide erroneous data, potentially causing delays in diagnosis of up to four years in men. These errors can provide erroneous estimates of the country’s diabetic prevalence and lead to incorrect clinical management. To overcome this problem, a resource-sensitive approach has been suggested. In resource-poor areas, diagnosis should be done using Oral Glucose Tolerance Tests (OGTT), while monitoring should be done using a combination of self-monitoring (SMBG) and basic haematological analyses. In a tertiary care setting, a combination of HbA1c, OGTT, and continuous glucose monitoring (CGM) should be done, along with other markers such as fructosamine. If needed, detailed iron studies and G6PD analysis should be carried out. The report stresses that monitoring should be done according to patient risk factors and available healthcare resources. In the end, using HbA1c alone in areas where anaemia is endemic is not sufficient; it is necessary to use it in combination with additional tests to provide an accurate diagnosis and correct clinical management of diabetes. Professor Anoop Misra, corresponding author and Chairman of Fortis C-DOC Center of Excellence for Diabetes.

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