Rachel V Thomas

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HbA1c Test May Not Be Accurate For Everyone: Who Should Not Rely On It?

<span>HbA1c</span>, also known as hemoglobin A1c or glycated hemoglobin, is a widely used blood test to diagnose and monitor <span><a href="https://www.healthandme.com/health/diabetes">diabetes</a></span>. However, ahead of <span>World <a href="https://www.healthandme.com/health/diabetes">Diabetes</a> Day</span>, experts have warned that the test may not be accurate for everyone.

HbA1c measures how much glucose is attached to hemoglobin in red blood cells, providing an estimate of average blood sugar levels over the previous two to three months.

Certain medical conditions and blood disorders can affect its accuracy, making readings appear higher or lower than actual blood sugar levels.

<h2>Who May Get Inaccurate HbA1c Results?</h2>

Conditions such as anemia and hemoglobin disorders can affect HbA1c readings by altering the lifespan of red blood cells.

"HbA1c can be misleading when conditions alter red blood cell lifespan. Iron, B12 or folate deficiency may falsely elevate HbA1c. Conversely, hemolytic anemia, certain hemoglobinopathies, chronic blood loss, recent transfusion and some kidney conditions can lower it falsely," Dr Manisha Arora, Director of Internal Medicine at CK Birla Hospital, Delhi, told <strong><em>HealthandMe</em></strong>.

Dr Sandeep Kharb, Senior Consultant – Endocrinology at Asian Hospital, added that iron-deficiency anemia can also lead to falsely high HbA1c readings.

Experts also cautioned that HbA1c is not a direct measure of insulin resistance. A person may be insulin resistant even before their HbA1c reaches the prediabetes threshold.

What Medical Conditions And Medications Can Affect HbA1c?

Iron, vitamin B12 and folate deficiencies, chronic alcohol use, high-dose aspirin and severe hypertriglyceridemia may contribute to falsely elevated readings.

Falsely low results can occur with hemolytic anemia, hemoglobin disorders, blood loss, transfusions, pregnancy, kidney disease and erythropoietin therapy.

Certain medicines, including dapsone, ribavirin and some antiretroviral drugs, can also affect HbA1c interpretation. The direction of the error depends on the underlying condition and the testing method.

<h2>Can Fasting Blood Sugar Be Normal While HbA1c Is High?</h2>

Dr Himika Chawla, Senior Consultant, Endocrinology and Diabetology at PSRI Hospital, told <strong><em>HealthandMe </em></strong>HbA1c reflects average blood sugar over two to three months, while fasting blood sugar measures glucose at a particular point in time.

A person may have normal <span>fasting glucose</span> but experience repeated blood sugar spikes after meals, pushing their HbA1c higher. The reverse mismatch can also occur.

Doctors therefore consider both results and the patient's overall clinical picture before making a diagnosis.

<h2>What Test Should Be Used To Diagnose Diabetes?</h2>

When HbA1c may not be reliable, doctors can use blood glucose-based tests, including fasting plasma glucose and the oral glucose tolerance test (OGTT).

"First test it should be oral glucose tolerance test," Dr Anoop Misra told NDTV.

For the test, a person eats their usual meals for three days and then fasts for eight to 10 hours before their fasting blood glucose is measured. They then drink 75 grams of glucose mixed in water, followed by another blood test two hours later.

Misra explained that fasting glucose below 100 mg/dL and a two-hour reading below 140 mg/dL are normal. Fasting levels of 100–125 mg/dL or two-hour readings of 140–199 mg/dL indicate prediabetes. Fasting glucose of 126 mg/dL or higher, or a two-hour reading of 200 mg/dL or higher, falls in the diabetes range.

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HbA1c, also known as hemoglobin A1c or glycated hemoglobin, is a widely used blood test to diagnose and monitor diabetes. However, ahead of World Diabetes Day, experts have warned that the test may not be accurate for everyone.HbA1c measures how much glucose is attached to hemoglobin in red blood cells, providing an estimate of average blood sugar levels over the previous two to three months.Certain medical conditions and blood disorders can affect its accuracy, making readings appear higher or lower than actual blood sugar levels.Who May Get Inaccurate HbA1c Results?Conditions such as anemia and hemoglobin disorders can affect HbA1c readings by altering the lifespan of red blood cells."HbA1c can be misleading when conditions alter red blood cell lifespan. Iron, B12 or folate deficiency may falsely elevate HbA1c. Conversely, hemolytic anemia, certain hemoglobinopathies, chronic blood loss, recent transfusion and some kidney conditions can lower it falsely," Dr Manisha Arora, Director of Internal Medicine at CK Birla Hospital, Delhi, told HealthandMe.Dr Sandeep Kharb, Senior Consultant – Endocrinology at Asian Hospital, added that iron-deficiency anemia can also lead to falsely high HbA1c readings.Experts also cautioned that HbA1c is not a direct measure of insulin resistance. A person may be insulin resistant even before their HbA1c reaches the prediabetes threshold.What Medical Conditions And Medications Can Affect HbA1c?Iron, vitamin B12 and folate deficiencies, chronic alcohol use, high-dose aspirin and severe hypertriglyceridemia may contribute to falsely elevated readings.Falsely low results can occur with hemolytic anemia, hemoglobin disorders, blood loss, transfusions, pregnancy, kidney disease and erythropoietin therapy.Certain medicines, including dapsone, ribavirin and some antiretroviral drugs, can also affect HbA1c interpretation. The direction of the error depends on the underlying condition and the testing method.Can Fasting Blood Sugar Be Normal While HbA1c Is High?Dr Himika Chawla, Senior Consultant, Endocrinology and Diabetology at PSRI Hospital, told HealthandMe HbA1c reflects average blood sugar over two to three months, while fasting blood sugar measures glucose at a particular point in time.A person may have normal fasting glucose but experience repeated blood sugar spikes after meals, pushing their HbA1c higher. The reverse mismatch can also occur.Doctors therefore consider both results and the patient's overall clinical picture before making a diagnosis.What Test Should Be Used To Diagnose Diabetes?When HbA1c may not be reliable, doctors can use blood glucose-based tests, including fasting plasma glucose and the oral glucose tolerance test (OGTT)."First test it should be oral glucose tolerance test," Dr Anoop Misra told NDTV.For the test, a person eats their usual meals for three days and then fasts for eight to 10 hours before their fasting blood glucose is measured. They then drink 75 grams of glucose mixed in water, followed by another blood test two hours later.Misra explained that fasting glucose below 100 mg/dL and a two-hour reading below 140 mg/dL are normal. Fasting levels of 100–125 mg/dL or two-hour readings of 140–199 mg/dL indicate prediabetes. Fasting glucose of 126 mg/dL or higher, or a two-hour reading of 200 mg/dL or higher, falls in the diabetes range.

hba1c test may not be accurate for everyone: who should not rely on it?

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