• India accounts for 17% of all diabetes patients in the world and most commonly-used tests to diagnose pre-diabetes and diabetes (both type 1 and type 2) and to help manage diabetes, is the haemoglobin A1C (HbA1C) test, also known as the glycated haemoglobin or glycosylated haemoglobin test.

Background

• According to a nationwide study published in 2023India is estimated to have 10.13 crore people with diabetes, and another 13.6 crore people who are pre-diabetic.
• All individuals older than 30 years should be screened for diabetes, according to the Indian Council of Medical Research’s Guidelines for Management of Type 2 Diabetes, 2018.
• 35% of Indians suffer from hypertension and nearly 40% from abdominal obesity, both of which are risk factors for diabetes. The American Diabetes Association approved HbA1c as a diagnostic tool for the same in 2009.

About HbA1c

• HbA1c was first discovered in 1955, elevated HbA1c levels in diabetes patients were not noted until 1968. Another eight years passed before HbA1c was correlated with blood glucose values in hospitalised patients with diabetes and was proposed for monitoring glycemia.
• The HbA1C levels are provided as either a percentage or in mmol/mol (which stands for millimoles per mole).
• The higher the percentage, the higher blood glucose levels are.
• An Hb1A1C below 5.7% is considered normal; between 5.7% and 6.4% may indicate you are pre-diabetic; and 6.5% or higher can indicate diabetes.
• In mmol/mol: below 42 corresponds to below 6.0%; 42-47 mmol/mol to 6.0 to 6.4%; and 48 mmol/mol to 6.5% or over.
• HbA1c test differs from others
• HbA1C test reflects your average blood glucose levels over the last two to three months, while the traditional blood sugar tests may fluctuate depending on items in the person’s latest meal and when they last consumed.

Limitations of HbA1C test

• Relatively low sensitivity arising from difficulties in assay standardisation.
• To obtain a clearer picture when diagnosing a person, a glucose test  is recommended with HbA1C test.
• In some clinical situations like thalassaemia, structural haemoglobin variants in the population, iron-deficiency anaemia (which is relatively high in India), and the use of certain drugs accurate measurements are harder to make.

Diabetes 

• Diabetes mellitus is a most common pancreatic endocrine disorder (Non-Communicable Disease) caused by deficient or failure of insulin secretion .
• On the basis insulin secretion it is categorised as: 
• Hyperglycaemia- Increase in blood sugar level
• Glycosuria- Excretion of excess glucose in the urine
• Polyuria- Frequent urination
• Polydipsia- Increased thirst
• Polyphagia- Increase in appetite

Types of Diabetes 

• Type 1 diabetes : Caused by an autoimmune reaction that stops your body from making insulin.
• Type 2 diabetes: Causes when body does not use insulin well and can’t keep blood sugar at normal levels.
• Gestational diabetes:  Caused by the insulin-blocking hormones that are produced during pregnancy.

Initiatives related to Diabetes

• National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was launched by India in 2010.
• Every year World Diabetes Day is observed on 14th November.