Narrative reviewindependent cross-checkabstract checked★ key study I-DIAB-108 in-depth review
When HbA1c can be misleading
The limitations and fallacies of relying on glycosylated hemoglobin for diagnosing and monitoring diabetes in Indian populations.
Overview
Samajdar SS et al.. Lancet Reg Health Southeast Asia 2026 · PMID 41743216 · DOI 10.1016/j.lansea.2026.100724
Anaemia, inherited haemoglobin disorders and G6PD deficiency can distort HbA1c, so it should be combined with direct glucose measurements.
Does the study support the specific claim? Partly · Methodological quality: low
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Review HbA1c pitfalls in India.
- How was the study done?
Narrative review.
- How many people, animals or samples were studied?
Not applicable.
- What was actually found?
HbA1c unreliable in some conditions.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
HbA1c is useful but must be interpreted with care.
- What are the study's limitations?
Narrative.
- What does it say about Elawady's specific claim?
Partly supports scepticism about HbA1c in specific conditions.
- Do the results apply to Germany and Europe?
Same caveats in Europe/Egypt.
- What can explicitly not be concluded from this study?
Cannot support abandoning HbA1c or glucose testing.
Scientific in-depth review
1. Full reference
- Authors
- Samajdar SS et al.
- Journal
- Lancet Reg Health Southeast Asia
- Year
- 2026
- Identifier
- PMID 41743216 DOI 10.1016/j.lansea.2026.100724
- Verification
- verified – PubMed efetch 2026-10-26; Crossref 2026-10-26
- Retracted
- no
- Corrections
ErratumIn Lancet Reg Health Southeast Asia 2026;47:100751 (not a retraction)
- Extent checked
- abstract only
- Conflicts of interest and funding
No funding; no competing interests (record).
2. Research question
What limits HbA1c reliability in India?
3. Study design and population
- Study design
- Narrative review – Narrative review
- Population
People with or at risk of diabetes in India
- Country
India
- Period
Literature review
- Sample size
Not applicable
- Inclusion and exclusion criteria
Not systematic
4. Methods and endpoints
- Exposure / intervention
Anaemia, haemoglobinopathies, G6PD deficiency, assay standardisation
- Comparator
Not applicable
- Endpoints
HbA1c accuracy
- Statistical methods
Not applicable
5. Actual results
- Results
High prevalence of anaemia, haemoglobinopathies and G6PD deficiency and poorly standardised assays complicate HbA1c interpretation; the authors recommend a multiparametric approach (OGTT, SMBG, CGM, haematological tests).
- Absolute risks
not reported
- Authors' conclusion
Reliance solely on HbA1c is constrained in India; combine with glucose measures.
6. Strengths
- Explicitly addresses HbA1c limitations
7. Weaknesses
- Narrative review
- India-specific
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Review.
9. Assessment of the statistical interpretation
Not applicable.
10. Relevance to the specific claim
Correct kernel: HbA1c can mislead in anaemia, haemoglobin disorders or G6PD deficiency (relevant also to Egypt); the remedy is to add glucose measurements, not to abandon measurement.
11. Independent contrary findings
12. Transferability to Germany and Europe
Haemoglobin variants and anaemia occur in Europe and Egypt; same caveat.
13. Overall methodological judgement
Supports a nuance, not the claim.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | low |
| Risk of bias | not assessable |
| Precision of results | not applicable |
| Directness | indirect |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |