However, panel emphasized that HbA1c can be used in settings where an appropriate standardized method is available. The results of the Chennai Urban Rural Epidemiology Study (CURES) demonstrated 88.0% sensitivity and 87.9% specificity for detection of diabetes when HbA1c cut off point is 6.1% (based on 2-h post load plasma glucose) and 93.3% sensitivity and 92.3% specificity when HbA1c cut off point is 6.4% (when diabetes was defined as FPG ≥7.0 mmol/l). These recommendations are based on the Indian evidencesĪ recent study conducted in Singapore residents of Chinese, Malay and Indian race to assess the performance of HbA1c as a screening test in Asian populations suggested that HbA1c is an appropriate alternative to FPG as a first-step screening test, and a combination of HbA1c with a cut-off of ≥6.1% and FPG level ≥100 mg/dL would improve detection in patients with diabetes.Ī study to assess the diagnostic accuracy and optimal HbA1c cutoffs for diabetes and prediabetes among high-risk south Indians suggested that HbA1c ≥6.5% can be defined as a cut-off for diabetes and HbA1c ≥5.9% is optimal for prediabetes diagnosis and value <5.6% excludes prediabetes/diabetes status.ĭata from a community based randomized cross sectional study in urban Chandigarh suggest that HbA1c cut point of 6.5% has optimal specificity of 88%, while cut off point of 7.0% has sensitivity of 92% for diagnosis of diabetes. ▫HbA1c cannot be used as 'sole’ measurement for diagnosis of diabetes in Indian settings. ▫HbA1c ≥6.5% as optimal level for diagnosis of diabetes in Indian patients Glycosylated haemoglobin cut off for diagnosis of diabetes in Indian patients Therefore, a combination of HbA1cand FPG would improve the identification of individuals with diabetes mellitus and prediabetes in limited resource settings like India. In lieu of this, the panel expressed concerns on using HbA1c as sole criteria for diagnosis of diabetes particularly in resource constraint settings. Also, in several countries including India, HbA1c demonstrated inadequate predictive accuracy in the diagnosis of diabetes, there is no consensus on a suitable cut-off point of HbA1c for diagnosis of diabetes in this high-risk population. Moreover, measuring HbA1c is expensive as compared to FPG assessments and standardization of measurement techniques and laboratories are poorly practiced across the country. However, given ethnic differences in sensitivity and specificity of HbA1c population-specific cut-offs might be necessary. Additionally, HbA1c has been recognized as marker to assess secondary vascular complications due to metabolic derailments in susceptible individuals. HbA1c testing has some substantial advantages over FPG and OGTT, such as convenience, pre-analytical stability, and less day-to-day fluctuations due to stress and illness. The International Expert Committee Report recommend a cut-point of ≥6.5% for HbA1c for diagnosing diabetes as an alternative to fasting plasma glucose (FPG ≥7.0 mmol/L). Both type 1 and type 2 Diabetes mellitus (DM) are diagnosed based on the plasma glucose criteria, either the fasting plasma glucose (FPG) levels or the 2-h plasma post-prandial glucose (2-h PPG) levels during a 75-g oral glucose tolerance test (OGTT), or the newer glycosylated haemoglobin (HbA1c) criteria which reflects the average plasma glucose concentration over the previous 8–12 weeks. The diagnostic criteria of diabetes have been constantly evolving. Members: Sujoy Ghosh, Nalini Shah, Usha Sriram, Rajesh Rajput Prasanna Kumar, Manoj Chawla, Ameya Joshi Members: Rajiv Kovil, Alok Sachan, Girish Varma Members: Mithun Bhartiya, Urman Dhruv, Premlata vartakaviĬoordinators: Siddhartha Das, A. Sharma, Vinay DhandhaniaĬoordinators: Samar Banerjee, P. Subramanian, Rucha MehtaĬoordinators: Subhankar Chowdhary, Jayant Panda Members: Shaileja Kale, Sudhir Bhandari, R. Members: Ashu Rastogi, Ghanshyam Goyal, Ashraf Ganie Lalwani, Hitesh PunyaniĬhronic Complications 2: Diabetic Foot and Peripheral Arterial DiseaseĬoordinators: S. Vijaykumar, Dheeraj KapoorĬhronic Complications 1: Retinopathy, Neuropathy, Diabetic Kidney DiseaseĬoordinators: Rajeev Chawla, Rakesh Sahay Members: Sushil Jindal, Kamlakar Tripathi, Narsingh Verma Members: Muralidharan, Santosh Singh, Rajesh Khadgawat
Members: Ajay Kumar, Sunil Jain, Sujit Jha Members: Vijay Panikar, Sameer Agarwal, V. Members: Parminder Singh, Sambit Das, Vageesh AyyarĬoordinators: Shashank Joshi, Krishna Seshadri Treatment 1: Medical Nutrition Therapy and Lifestyle Modification Ramachandran, Eesh Bhatia, Amitesh Agarwal Prevention (Including Screening and Early Detection)
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