The Aryavarth Express
New Delhi: Amid discussions sparked by a recent Lancet study on diabetes diagnosis, leading diabetologist Dr V. Mohan has emphasised that blood glucose testing remains the most reliable method for diagnosing diabetes, cautioning against using HbA1c as a standalone diagnostic tool.
Speaking on the issue, Dr Mohan, Chairman of Mohan’s Diabetes Specialities Centre, said that while HbA1c (glycated haemoglobin) is considered the gold standard for assessing long-term blood sugar control, it is not the gold standard for diagnosing diabetes.
“This article is a review article. HbA1c is the gold standard for assessing long-term control of diabetes, but it is not the gold standard for diagnosing diabetes. Glucose still remains the best test for diagnosis,” he said.
Dr Mohan also pointed out practical challenges in India, noting that many laboratories may not be adequately equipped for accurate HbA1c testing. He warned that relying solely on HbA1c could inflate diabetes prevalence figures.
“HbA1c cannot be used as a single test. In our studies, we found that using HbA1c doubles the prevalence of diabetes. The test may pick up people with very mild abnormalities and label them as having diabetes. Do not use HbA1c alone for diagnosis,” he added.
His remarks follow a new evidence-based Viewpoint published in The Lancet Regional Health – Southeast Asia, which raised concerns about the reliability of HbA1c testing in India and other South Asian countries.
The publication highlighted that HbA1c levels can be affected by conditions that alter haemoglobin quantity, structure, or lifespan—such as anaemia, hemoglobinopathies, and glucose-6-phosphate dehydrogenase (G6PD) deficiency. These conditions are relatively common in parts of India and may distort HbA1c values, leading to inaccurate assessments of average blood glucose levels.
“Relying exclusively on HbA1c can result in misclassification of diabetes status,” said Professor Anoop Misra, corresponding author of the article and Chairman of Fortis C-DOC Centre of Excellence for Diabetes. “Some individuals may be diagnosed later than appropriate, while others could be misdiagnosed, affecting timely management. Monitoring of blood sugar levels may also be compromised.”
Co-author Dr Shashank Joshi from Mumbai noted that even in well-equipped urban hospitals, HbA1c readings can be influenced by inherited haemoglobin disorders and red blood cell variations. He added that discrepancies may be more pronounced in rural and tribal regions, where anaemia and related conditions are more prevalent.
The experts collectively stressed the importance of using plasma glucose measurements alongside HbA1c, rather than depending on a single test, to ensure accurate diagnosis and effective diabetes management.
