Docs may be wrongly tagging patients as diabetics

Docs may be wrongly tagging patients as diabetics

Pushpa.Narayan@timesgroup.com

Chennai:09.10.2021

Several senior citizens may be wrongly tagged diabetic and pre-diabetic based on the elevated levels of blood sugar seen in the glycated haemoglobin (HbA1c) – a standard test for diabetes, senior diabetologists say. They have now called for age-specific cut-offs for the test to minimise risks of needless treatment and its side effects.

Results from a pan India study, published in Acta Dibetologica, shows the HbA1c levels increase with age in nondiabetic individuals. “This means, we cannot have the same normal for all adults. Laboratories should report age adjusted normal values for all their lab tests,” said senior diabetologist Dr V Mohan from the Madras Diabetes Research Foundation. “Else, we will be initiating needless treatment in elderly people and increase risk of serious side effects of the medicines,” he said.

The test is done to find the average level of blood sugar over three months and is hence considered robust and reliable. When glucose builds up in the blood, it binds to the haemoglobin —a protein found in red blood cells. Since these cells live for three months, the test shows the average level of glucose in blood for the three months. If the level is below 5 and 5.6%, its considered normal and those who have values between 5.7 and 6.4% are considered prediabetic. The value for diabetics is above 6.5%.

Scientists used data collected from the Indian Council of Medical Research – INdia DIABetes (ICMR–INDIAB) study in people above 20 years from across India. The age-wise distribution of HbA1c from 14,222 people showed in this group. Scientists used data from 1,077 others from the CURES study conducted in Chennai for validation. Analysis showed HbA1c levels increased gradually with age from about 5.16 in the 20–29 years group to 5.49% in those above 70 years. The validation study (CURES) showed HbA1c was 5.35% in 20–29 years and 5.74% in above

70.

“The pan India data showed a 0.08% increase in HbA1c for every decadal increase in age. This increase was more significant in women and urbanites. “Many elderly people may have physiological changes in their ability to regulate blood glucose. This means marginally elevated HbA1c levels need not always be indicative of pathology,” said diabetologist Dr R M Anjana, who was a part of the study.