Overview
- In a Lancet Regional Health viewpoint, Indian diabetologists warn that relying on HbA1c alone can misclassify diabetes in populations with iron‑deficiency anaemia, haemoglobinopathies, and G6PD deficiency.
- Men with undiagnosed G6PD deficiency could face diabetes diagnosis delays of up to four years if assessed only by HbA1c, increasing the risk of complications.
- Public‑health estimates based solely on HbA1c may be distorted, with one cited exercise showing a shift from roughly 110 million cases by glucose measures to about 200 million using HbA1c.
- The paper proposes resource‑stratified protocols: fasting glucose plus a two‑hour OGTT for diagnosis, self‑monitoring two to three times weekly in low‑resource settings, and in tertiary care the use of OGTT alongside HbA1c, CGM, and alternative markers such as fructosamine, with targeted haematologic tests when indicated.
- High anaemia prevalence in India (NFHS‑5 reports over 57% of women and about 25% of men) and inconsistent HbA1c assay standardisation compound inaccuracies, and clinicians are being urged to reassess protocols, though no national guideline change has been announced.