Hemoglobin A1C (HbA1c) Test for Diabetes Management

Context: According to a nationwide study published in 2023, India’s population of individuals with diabetes is estimated at 101.3 million, with an additional 136 million categorised as pre-diabetic.

HbA1C Test: A Key Tool for Diabetes Management

• What it is: A blood test to diagnose pre-diabetes, and diabetes (type 1 and type 2), and monitor diabetes management
• How it works: Measures the percentage of red blood cells with sugar-coated haemoglobin (HbA1C)
• Why it’s used for diabetes: Reflects average blood sugar levels over 2-3 months, unlike blood sugar tests that give a snapshot.

HbA1C Test Results and Interpretation

• Results provided as a percentage or mmol/mol
• Normal HbA1C level: Below 5.7%
• Pre-diabetic range: 5.7% to 6.4%
• Diabetic range: 6.5% or higher
• Factors affecting test results: Kidney or liver problems, blood disorders, pregnancy, certain medications

Who Needs the HbA1C Test and When

• Recommended for all adults above 30 years old
• Earlier screening is advised for people with risk factors like obesity, high blood pressure, heart disease
• Retesting frequency: Every 3 years for normal results, annually for pre-diabetes, more frequently during pregnancy
• For diagnosed diabetes: Every 3-6 months to monitor blood sugar control and treatment effectiveness

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HbA1C Test vs. Other Blood Sugar Tests

• HbA1C vs. Fasting/post-meal blood sugar tests: HbA1C reflects average blood sugar over time, not dependent on recent meals
• HbA1C complements, not replaces, other tests and regular blood sugar monitoring

Limitations of the HbA1C Test

• Not a standalone test, may be used with other tests for diagnosis
• Doesn’t capture blood sugar spikes or dips throughout the day
• Less sensitive in certain conditions (anaemia, genetic variations) – may require additional glucose tests for diagnosis
• In India, test accuracy may be affected by factors like iron deficiency and haemoglobin variants

Measures to Tackle Diabetes in India

• Prioritise Prevention: Public awareness campaigns promoting healthy lifestyles to prevent pre-diabetes from progressing to diabetes.
• Focus on Early Detection: Regular screenings, especially for high-risk individuals, to identify new cases and enable early intervention.
• Lifestyle Modifications: Encourage a healthy diet, sufficient exercise, and regular blood sugar monitoring to maintain good control.
• Address Regional Disparities: Implement preventive measures in both urban and rural areas, considering the shift towards modern lifestyles.

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