New Delhi | 10 February 2026 — A widely used medical test for diagnosing and monitoring diabetes — the HbA1c test — may give misleading results for millions of people across South Asia, particularly in India, according to a new scientific analysis published in The Lancet Regional Health: Southeast Asia. The findings have significant implications for diabetes care, diagnosis, and public health strategies across the region.
What Is the HbA1c Test?
The HbA1c test, or glycated hemoglobin test, measures the percentage of hemoglobin proteins in the blood that are coated with glucose (sugar). It reflects the average blood glucose level over the past two to three months and is widely used because it does not require fasting and gives a long-term view of sugar control.
Why the Test May Be Misleading
The Lancet analysis highlights that relying solely on the HbA1c test can lead to inaccurate or delayed diabetes diagnosis in populations where certain blood conditions are common. These include:
- Anaemia and Iron Deficiency — with high prevalence in many parts of India, anaemia affects the number and lifespan of red blood cells, which can distort HbA1c readings.
- Inherited Hemoglobin Disorders (Haemoglobinopathies) — genetic variations in hemoglobin structure can affect how glucose attaches to red blood cells.
- G6PD Deficiency and Other Red Cell Enzyme Disorders — these conditions alter red cell survival and can lead to falsely low HbA1c levels, masking high blood sugar levels.
Because these factors influence red blood cells directly, the HbA1c test may underestimate or overestimate true glucose levels, leading doctors to misclassify a patient’s diabetes status — either failing to diagnose diabetes early, or diagnosing it when it may not be present.
Potential Impact on Diagnosis and Treatment
Experts warn that such misclassification can delay timely treatment and increase the risk of long-term diabetes complications. In men with undiagnosed G6PD deficiency, reliance on HbA1c alone could potentially delay the diagnosis by up to four years, increasing health risks and complicating management.
The implications extend beyond individual care: public health surveys and national diabetes prevalence estimates that depend on HbA1c measurements may misrepresent the true burden of the disease, affecting planning and resource allocation.
Experts Call for a Broader Diagnostic Approach
Leading endocrinologists involved in the study, including Prof. Anoop Misra and Dr. Shashank R. Joshi, recommend that clinicians combine HbA1c with other tests such as:
- Fasting Plasma Glucose (FPG)
- Oral Glucose Tolerance Test (OGTT)
- Self-monitoring of blood glucose
- Additional hematologic assessments
This multi-parameter approach can offer a more accurate picture of a person’s blood sugar status, particularly in communities with high anaemia and blood disorder rates.
Looking Ahead: Tailored Diagnostic Strategies
While the HbA1c test remains useful for monitoring glucose trends, the authors stress that it should not be the sole diagnostic tool in South Asian populations. Instead, healthcare providers and policy makers should adapt diagnostic algorithms to include complementary tests — especially in settings where red blood cell disorders are endemic.
The Lancet study’s findings serve as a major wake-up call for clinicians and public health officials alike: understanding the limitations of standard tests like HbA1c is crucial for accurate diabetes diagnosis, effective management, and better long-term health outcomes for millions of patients across the region.
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