Doctor Explains 4 Major HbA1c Blood Sugar Test Myths Keeping Indians On The Wrong Diabetes Path

Every year, millions of Indians walk out of pathology labs clutching a report that says their HbA1c is "normal", and assume they're safe from diabetes. That assumption is costing us dearly. India already has over 100 million people living with diabetes, and a significant reason for this epidemic is that we've built our entire screening strategy around a single number that tells only part of the story.

Here are the myths that need to go.

Myth 1: If your HbA1c is below 6.5%, you don't have a diabetes problem

This is the most dangerous assumption in Indian metabolic health. HbA1c measures your average blood glucose over three months. It tells you where your sugar has been, not where it's heading. By the time HbA1c crosses 6.5%, insulin resistance has typically been building silently for five to ten years. Your pancreas has been overworking, your beta cells have been deteriorating, and the metabolic damage is already advanced. A "normal" HbA1c doesn't mean your metabolism is healthy. It may simply mean your body is still compensating, for now.

Myth 2: HbA1c is equally reliable for everyone

It isn't, and this matters enormously in India. HbA1c can read artificially low in people with iron deficiency anaemia, thalassaemia trait, or recent blood loss. These are not rare conditions in our population; iron deficiency affects nearly half of Indian women. A falsely low HbA1c offers reassurance where concern is warranted, delaying intervention precisely when early action would be most effective.

Also Read: Doctor Shares Better Tests Than HbA1c To Spot And Fix Diabetes Early

Myth 3: HbA1c is the best early detection tool available

It's a good monitoring tool. It's a poor early warning system. Fasting insulin and HOMA-IR, a calculated score combining fasting insulin with fasting glucose, detect insulin resistance years before HbA1c moves. A person with normal blood sugar but elevated fasting insulin is already metabolically compromised; their body is simply masking the problem. This is the stage where reversal is most achievable, and HbA1c misses it entirely.

Continuous glucose monitoring adds another dimension, revealing post-meal glucose spikes and overnight variability that a single fasting test never captures. I routinely see patients with textbook-normal HbA1c whose CGM data shows glucose exceeding 180 mg/dL after meals, a pattern that drives organ damage long before standard tests raise a flag.

Myth 4: Once HbA1c confirms diabetes, medication is the only answer

This is where the most consequential myth takes hold. The standard script, metformin first, then additional medications, then perhaps insulin, treats diabetes as a permanent condition requiring lifelong management. But Type 2 diabetes is fundamentally a metabolic dysfunction, not a medication deficiency. When caught early, particularly when beta cell function is still preserved, structured intervention can achieve what's now formally recognised as remission: non-diabetic blood glucose levels without diabetes medications, sustained over time.

What works isn't a miracle diet. It's coordinated action, building muscle to improve insulin sensitivity (muscle acts as a glucose sink even at rest), time-restricted eating with adequate protein intake of 25-30 grams per meal, and a clinical team adjusting medications, nutrition, and exercise in concert rather than in isolation. The landmark DiRECT trial demonstrated that nearly half of participants achieved remission at one year with structured intervention.

Also Read: India's Diabetes Burden: Healthy Eating Tips To Reduce Risk Of Type 2 Diabetes

The Path Correction India Needs

We need to stop treating HbA1c as the gatekeeper of metabolic health and start using it as one tool among several. Fasting insulin, HOMA-IR, CGM data, ApoB, and HsCRP together paint a complete metabolic picture, one that allows us to intervene years earlier, when the condition is most reversible.

The next time your report shows a "normal" HbA1c, ask your doctor one additional question: what's my fasting insulin? That number might tell you what HbA1c won't.

(By Dr. Gagandeep Singh, MBBS, Founder - Redial Clinic | Specialist in Reversing Diabetes, Hypertension, Obesity & PCOS without Medication)

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