Why in News?
- A study published, The Lancet Regional Health-Southeast Asia warns that over-reliance on HbA1c for type-2 diabetes diagnosis and monitoring in India leads to underdiagnosis and delayed treatment for millions.
About
- HbA1c readings are distorted by high rates of iron deficiency anemia (affecting over half of adults in some areas), hemoglobin disorders like sickle cell disease, and G6PD deficiency, which falsely elevate or lower results.
- This could delay diagnosis by up to 4 years in cases like undetected G6PD deficiency in men, raising complication risks; public health surveys using only HbA1c may also misrepresent India's diabetes burden (101 million cases).
India’s Context
- India has the world's highest diabetes prevalence, yet anemia is endemic, making HbA1c unreliable as a standalone "gold standard" test (measures average blood sugar over 2-3 months).
- Inconsistent lab quality control adds to accuracy issues; one south India study found oral glucose tolerance test (OGTT) detected far more prediabetes cases (87.8%) than HbA1c (45.4%).
- Use OGTT (fasting + 2-hour post-glucose) for diagnosis in low-resource settings; combine self-monitoring blood glucose (SMBG) 2-3 times weekly with basic hematology screening.
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