New Delhi: The generally used HbA1c blood check for diagnosing and monitoring diabetes could give deceptive leads to tens of millions of individuals throughout South Asia, notably in India, as a result of excessive prevalence of anaemia and inherited blood problems, 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 mirror common blood glucose by measuring glycation of haemoglobin—can both under- or overestimate true blood sugar ranges in people with circumstances affecting purple blood cells, together with iron deficiency anaemia, haemoglobinopathies and glucose-6-phosphate dehydrogenase (G6PD) deficiency.
“In areas like India, the place dietary anaemia and purple blood cell problems are widespread, unique reliance on HbA1c can lead to misclassification of diabetes standing,” Prof Misra, Chairman of Fortis C-DOC Middle of Excellence for Diabetes, mentioned.
The authors word 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 analysis and long-term monitoring of diabetes. The evaluate additionally cautions that undetected G6PD deficiency in males may delay diabetes analysis by as much as 4 years, doubtlessly growing the danger of problems.Shashank R Joshi, endocrinologist at Joshi Clinic, Mumbai, mentioned HbA1c variability could also be noticed even in well-equipped city hospitals because of purple blood cell abnormalities. “In rural and tribal areas, the place anaemia and inherited blood problems are extra widespread, discrepancies could also be even better,” 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 could due to this fact underestimate or misrepresent India’s true diabetes burden, the examine mentioned.
The evaluate recommends a resource-adapted method to diabetes analysis and monitoring. In low-resource settings, it suggests using oral glucose tolerance checks (OGTT) for analysis together with periodic self-monitoring of blood glucose and primary haematological screening. In tertiary care centres, a mix of HbA1c, OGTT, steady glucose monitoring and various biomarkers similar to fructosamine is suggested.
Dr Shambho Samrat Samajdar, a co-author from Kolkata, mentioned combining glucose-based checks with haematological assessments offers a extra correct image of diabetes danger and will assist refine public well being estimates and useful resource allocation.
The authors conclude that in international locations the place anaemia and blood problems are endemic, HbA1c shouldn’t be utilized in isolation however alongside complementary checks for efficient diabetes analysis and administration.
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