Beyond the Fingerstick: The Shift to HbA1c for Diabetes Diagnosis

Glycated Haemoglobin (HbA1c) offers an estimate of long-time period average glycaemic status.It is used routinely to evaluate glycaemic control in diabetic to gain treatment goals and prevent long term complications.Its advice for analysis of diabetes mellitus has evoked mixed reaction worldwide.We reviewed some of published articles to investigate the pros and cons of the use of HbA1c for analysis of Diabetes mellitus in India.We found that though HbA1c has some indisputable advantages over fasting plasma glucose estimation for diagnosing diabetes mellitus, some of biochemical, clinical and economic factors limit its use as single diagnostic agent.Diagnostic techniques and laboratories are insufficiently standardized for HbA1c in India.The clinician needs to remember the overall patient profile in addition to a number of local variations and disorders especially hemoglobinopathies /anaemias earlier than accepting an unusual HbA1c value.Supportive or repeat tests may be required leading to increase in cost and delay in diagnosis.In the present Indian scenario, especially the fragmented unorganized health care sector in suburban areas, HbA1c cannot be accepted as a sole and independent test to diagnose diabetes mellitus.