Twin states split on diabetes test meter
Are you diabetic? Your fate hinges on which of the three regions in AP and Telangana you hail; from. If you are a Rayalaseema native, you are declared diabetic, If your glycated blood reading (HbA1c) is above 6.3.
But you not to panic till your reading crosses 6.5, if you are Hyderabadi or from Telangana. Globally, the common cut-off limit for blood sugar average over a period of eight weeks is 6.5. Doctors in India also follow the Western parameter of 6.5 to affirm diabetic status.
Doctors and researchers from AP and Telangana are now split over the cut-off mark for the HbA1c test. The immediate trigger for debate in the medical fraternity in the twin states is a research study published by doctors from Tirupati, making 6.3 as the cut-off. Research covering all four districts of Rayalaseema appeared in the latest issue of the Indian Journal of Medical Research (IJMR) published by Indian Council of Medical Research (ICMR), the country’s premier medical research study.
In the last 10 years, HbA1c emerged as a reliable test to determine diabetes and doctors now prefer this test over traditional fasting and post-lunch blood-sugar tests. While many doctors accept the universal standard of 6.5 cut-off mark, researchers from Rayalaseema argue there should not be one HbA1c parameter for all populations. They said it differs from regions to ethnic groups. The debate assumes importance in a backdrop of rising diabetes cases in AP and Telangana. The cut-off mark is important as patients will be put to unnecessary or wrong medication that can cause health complications. The research team from Sri Venkateswara Institute of Medical Sciences, Sri Venkateswara University, and Harshitha Hospital, Tirupati, and Indian Institute of Technology-Madras, said the validity of HbA1c needs to be established in ethnic populations.
Even within AP and Telangana, people have different lifestyles and food habits. For instance, people in the Godavari, Krishna, and Guntur districts consume more rice, compared to people in rural Telangana and Rayalaseema, where jowar, wheat, and millets are popular. In Hyderabad, lack of exercise and rapid urbanization have taken a heavy toll.
Speaking to TOI, Dr. Harikishan Boorugu, consultant physician, Apollo hospitals, said “Several factors like age, ethnicity and genetic makeup of people influence HbA1c results. The test may be different for the same level in different countries and different ethnic populations. There are studies from various countries which looked at optimal HbA1c cutoff for diagnosing diabetes. The level fixed for Rayalaseema can be applied to people in Telangana and coastal Andhra. But 6.3 limit is not endorsed by Indian Endocrinology Association,” he said.
“The 6.5 mark or above is recommended as the cut-off mark for diagnosing diabetes, although a value less than 6.5 does exclude diabetes using glucose tests,” said consultant endocrinologist Dr. Ravi Shankar Erukulapati.
Another endocrinologist Dr, Sridevi Paladugu suggests there should be research studies on populations in different regions to decide cut-off.
However, Dr. Aftab Ahmed, the specialist in internal medicine, points out that risk of microvascular and cardiovascular disease starts when HbA1c is between 5.7 and 6.4, one should follow a strict lifestyle regime if diagnosed as pre-diabetic.
Senior consultant in internal medicine Dr. Y Ganesh said the diversity of Indian population said, “We need many population-based studies to confirm whether we can have difference HbA1c values for Andhra Pradesh and Telangana.”