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

A patient recently showed me his annual health check-up, blood sugar normal, HbA1c 5.8%, cholesterol "borderline." His doctor told him to watch his diet and come back next year. When I ran a fuller metabolic panel, the picture was entirely different: fasting insulin three times optimal, a HOMA-IR score deep in the insulin-resistant range, and a triglyceride-to-HDL ratio that flagged serious cardiovascular risk. This man wasn't a year away from a problem. He was already in one, his standard tests simply couldn't see it.

This is the gap that's fuelling India's diabetes epidemic. We're diagnosing the condition after it's entrenched, when the tools to catch it five to ten years earlier already exist.

Why HbA1c Alone Isn't Enough

HbA1c measures average blood glucose over three months. It's valuable for monitoring diagnosed diabetics, but as an early detection tool, it has a critical blind spot: it only rises after your pancreas has been failing for years. By the time HbA1c crosses 6.5%, insulin resistance is well advanced and beta cell function is already compromised. It also reads artificially low in people with iron deficiency anaemia or thalassaemia trait, conditions widespread in the Indian population, offering false reassurance to those most at risk.

HbA1c tells you where your blood sugar has been. The tests below tell you where it's going.

Fasting Insulin and HOMA-IR: The Earliest Alarm

Fasting insulin measures how hard your pancreas is working to keep glucose in the normal range. HOMA-IR combines this with fasting glucose to produce a single insulin resistance score. A person with normal blood sugar but elevated fasting insulin is already metabolically compromised, their body is compensating, and that compensation has an expiry date. This is the earliest measurable stage of diabetes risk, and crucially, the most reversible. Yet most annual health packages in India don't include either test.

TG/HDL Ratio: The Metabolic Red Flag Hiding in Plain Sight

Here's something remarkable, a powerful marker of insulin resistance is already sitting in most people's existing blood work, unread. The triglyceride-to-HDL cholesterol ratio is one of the strongest surrogate markers of insulin resistance and cardiovascular risk. A ratio above 3.0 (in mg/dL) strongly correlates with the small, dense LDL particles that drive arterial damage, and with the metabolic syndrome pattern common in South Asian populations. Unlike fasting insulin, this requires no additional test, it simply requires your doctor to look at the lipid panel differently.

Continuous Glucose Monitoring: The Full Picture

A single fasting glucose reading is a snapshot. CGM tracks glucose continuously for days, revealing post-meal spikes, overnight patterns, and glycaemic variability that routine tests miss entirely. I regularly see patients with normal HbA1c whose CGM data shows glucose exceeding 180 mg/dL after meals, a pattern driving organ damage long before standard markers react.

ApoB and HsCRP: Completing the Metabolic Picture

ApoB counts the actual atherogenic particles driving cardiovascular risk, far more precise than standard LDL cholesterol. HsCRP captures the low-grade chronic inflammation that accompanies insulin resistance. Together with the markers above, they reveal the full metabolic reality that HbA1c alone never will.

Early Detection Only Matters If It Leads to Early Action

When we catch insulin resistance at the HOMA-IR stage, the interventions are effective and well-evidenced: body recomposition through resistance training (muscle acts as a glucose sink even at rest), time-restricted eating paired with 25-30 grams of protein per meal, and coordinated care from a physician, nutritionist, and fitness professional working as a team. This is how diabetes gets reversed, not managed.

The tests exist. The evidence exists. The missing piece is asking for them before HbA1c gives you the bad news too late.

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

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