The limitations and fallacies of relying on glycosylated hemoglobin for diagnosing and monitoring diabetes in Indian populations

Glycated hemoglobin (HbA1c) is commonly used to diagnose and monitor type 2 diabetes (T2D). However, in South Asia-particularly India-the high prevalence of anemia, hemoglobinopathies, and glucose-6-phosphate dehydrogenase (G6PD) deficiency, and poorly standardized HbA1c assay methods complicates the interpretation of HbA1c values, challenging its reliability in both diagnosis and monitoring of diabetes. Overall, reliance solely on HbA1c is constrained by several clinical and biological factors in India. A multiparametric, risk-stratified approach that integrates oral glucose tolerance test, self-monitoring of blood glucose, and whenever possible, continuous glucose monitoring, in addition to relevant hematologic assessments are essential to enhance diagnostic and monitoring accuracy and inform appropriate treatment decisions, especially in primary care and resource-limited settings. Funding: No funding was received for this work.