Study warns HbA1c test may fail diabetes detection in Indians
For years, doctors have used one main test to track and diagnose diabetes: HbA1c. It is often called the “gold standard”. But a new study has warned that this test can be wrong for many South Asians, especially Indians. The research, published in The Lancet Regional Health: Southeast Asia, says that depending only on HbA1c could lead to many people being missed or diagnosed late.
Why the HbA1c test can fail
HbA1c estimates your average blood sugar over the last 2-3 months. It works by measuring how much sugar has attached to haemoglobin, the protein inside red blood cells.
The problem is: the test assumes red blood cells are “normal.” But in India, many people have blood-related conditions such as:
- Anaemia (very common)
- Iron deficiency
- Genetic disorders like thalassemia
- Enzyme issues like G6PD deficiency
These conditions can change how long red blood cells live. If red blood cells die earlier than usual, they have less time to collect sugar, so HbA1c can look lower than it should. That can make someone appear healthy even if their blood sugar is actually high.
Delayed diagnosis can be dangerous
The study gives a serious example: in men with G6PD deficiency, diabetes diagnosis could be delayed by up to four years.
That delay matters because high blood sugar can quietly damage the body over time, especially the eyes, kidneys, heart, and nerves. By the time diabetes is detected, complications may already be advanced.
Professor Anoop Misra, one of the lead authors, warns that using only HbA1c can lead to wrong classification, meaning some people are missed, and others are diagnosed too late.
Why do South Asians face a higher risk?
South Asians already have a higher genetic risk for diabetes. But many diabetes tests and standards were developed and tested mainly on Western populations, which often have different blood-health patterns.
The study also notes that errors can happen even in good hospitals. In rural areas, the risk may be higher because anaemia and malnutrition are more common, creating a “double burden”: people may have diabetes, but it stays hidden because anaemia affects the test result.
What doctors should do instead?
The researchers say we should not rely on just one test.
They recommend using the Oral Glucose Tolerance Test (OGTT) more often. In OGTT:
- Blood sugar is checked first (fasting)
- The person drinks a sugary liquid
- Blood sugar is checked again after a set time
It takes more effort, but it can be more reliable, especially when anaemia is present.
They suggest a practical approach:
- In cities: use HbA1c, but confirm with other tests too.
- In rural areas, use OGTT as the main tool when possible.
- Encourage home glucose monitoring where appropriate.
Why this matters for disaster and environmental health
This is not just a hospital issue. Diabetes makes emergencies worse. During heatwaves, floods, or long power cuts, people often struggle to store medicines, follow a proper diet, or reach doctors. If many people are missed or diagnosed late, the health system is carrying a hidden load that becomes a bigger problem in every climate-related crisis.
The study’s message is simple: one test cannot work perfectly for everyone in a diverse country like India. Screening needs to match real biology, reliable lab practices, and local health risks.
For readers, the safest point is this: don’t decide your health status from just one lab report. If your symptoms are strong or your risk is high, talk to a doctor and ask for confirmatory tests.
#DiabetesAwareness #HealthNews #HbA1c #IndianHealth #TheLancet #MedicalResearch #PublicHealth #SouthAsianHealth #DiabetesIndia #IronDeficiency #G6PDDeficiency #OralGlucoseToleranceTest
Study warns HbA1c test may fail diabetes detection in Indians
For years, doctors have used one main test to track and diagnose diabetes: HbA1c. It is often called the “gold standard”. But a new study has warned that this test can be wrong for many South Asians, especially Indians. The research, published in The Lancet Regional Health: Southeast Asia, says that depending only on HbA1c could lead to many people being missed or diagnosed late.
Why the HbA1c test can fail
HbA1c estimates your average blood sugar over the last 2-3 months. It works by measuring how much sugar has attached to haemoglobin, the protein inside red blood cells.
The problem is: the test assumes red blood cells are “normal.” But in India, many people have blood-related conditions such as:
- Anaemia (very common)
- Iron deficiency
- Genetic disorders like thalassemia
- Enzyme issues like G6PD deficiency
These conditions can change how long red blood cells live. If red blood cells die earlier than usual, they have less time to collect sugar, so HbA1c can look lower than it should. That can make someone appear healthy even if their blood sugar is actually high.
Delayed diagnosis can be dangerous
The study gives a serious example: in men with G6PD deficiency, diabetes diagnosis could be delayed by up to four years.
That delay matters because high blood sugar can quietly damage the body over time, especially the eyes, kidneys, heart, and nerves. By the time diabetes is detected, complications may already be advanced.
Professor Anoop Misra, one of the lead authors, warns that using only HbA1c can lead to wrong classification, meaning some people are missed, and others are diagnosed too late.
Why do South Asians face a higher risk?
South Asians already have a higher genetic risk for diabetes. But many diabetes tests and standards were developed and tested mainly on Western populations, which often have different blood-health patterns.
The study also notes that errors can happen even in good hospitals. In rural areas, the risk may be higher because anaemia and malnutrition are more common, creating a “double burden”: people may have diabetes, but it stays hidden because anaemia affects the test result.
What doctors should do instead?
The researchers say we should not rely on just one test.
They recommend using the Oral Glucose Tolerance Test (OGTT) more often. In OGTT:
- Blood sugar is checked first (fasting)
- The person drinks a sugary liquid
- Blood sugar is checked again after a set time
It takes more effort, but it can be more reliable, especially when anaemia is present.
They suggest a practical approach:
- In cities: use HbA1c, but confirm with other tests too.
- In rural areas, use OGTT as the main tool when possible.
- Encourage home glucose monitoring where appropriate.
Why this matters for disaster and environmental health
This is not just a hospital issue. Diabetes makes emergencies worse. During heatwaves, floods, or long power cuts, people often struggle to store medicines, follow a proper diet, or reach doctors. If many people are missed or diagnosed late, the health system is carrying a hidden load that becomes a bigger problem in every climate-related crisis.
The study’s message is simple: one test cannot work perfectly for everyone in a diverse country like India. Screening needs to match real biology, reliable lab practices, and local health risks.
For readers, the safest point is this: don’t decide your health status from just one lab report. If your symptoms are strong or your risk is high, talk to a doctor and ask for confirmatory tests.
#DiabetesAwareness #HealthNews #HbA1c #IndianHealth #TheLancet #MedicalResearch #PublicHealth #SouthAsianHealth #DiabetesIndia #IronDeficiency #G6PDDeficiency #OralGlucoseToleranceTest
