Anaemia, blood disorders can distort diabetes test HbA1c results, says study, Pg12

Key Highlights:

• A study in Lancet Regional Health: Southeast Asia, led by Anoop Misra, indicates that HbA1c tests for Type 2 diabetes (T2D) may be unreliable in South Asia, especially India.
• High prevalence of anaemia, haemoglobinopathies like sickle cell disease and thalassaemia, and G6PD deficiency can distort HbA1c results.
• Sole reliance on HbA1c may delay diagnosis by up to four years in men with undetected G6PD deficiency, increasing complication risks.
• The study suggests a multiparametric approach integrating oral glucose tolerance test, self-monitoring of blood glucose, and continuous glucose monitoring for accurate diagnosis.

Detailed Insights:

• HbA1c, a common diagnostic tool for T2D, measures glycated haemoglobin levels to estimate average blood glucose over 2-3 months.
• Conditions affecting haemoglobin quantity, structure, or lifespan, such as anaemia and haemoglobinopathies, can distort HbA1c values, leading to inaccurate blood glucose estimations.
• Poorly standardized HbA1c assay methods further complicate the interpretation of HbA1c values, especially in resource-limited settings.
• In regions with nutritional challenges and iron-deficiency anaemia, HbA1c readings can be significantly distorted, affecting both diagnosis and monitoring of diabetes.
• A multiparametric approach, including oral glucose tolerance tests and continuous glucose monitoring, is essential for accurate diagnosis and treatment decisions, particularly in primary care.
• In Type 1 diabetes, a non-linear relationship between mean blood glucose and HbA1c has been observed, further complicating the use of HbA1c as a reliable marker.

Key Concepts Involved:

• HbA1c: Glycated haemoglobin, a measure of average blood glucose levels over 2-3 months.
• Anaemia: A condition characterized by a deficiency of red blood cells or haemoglobin in the blood.
• Haemoglobinopathies: Genetic disorders affecting the structure or production of haemoglobin.
• G6PD Deficiency: A genetic disorder that affects red blood cells, potentially leading to anaemia.