India has one of the largest diabetic populations in the world, and Indians develop type 2 diabetes roughly a decade earlier and at lower body weights than Western populations.
The single most useful number in managing it is HbA1c, and most patients do not know what it actually measures.
What HbA1c Measures
Glucose in the blood attaches to haemoglobin in red blood cells. Since red cells live around three months, the proportion of haemoglobin carrying glucose reflects the average blood sugar over roughly the preceding eight to twelve weeks.
That is why HbA1c cannot be improved by eating carefully for three days before the test, a strategy many patients attempt. It reflects the whole period, weighted slightly toward the most recent weeks.
It is also why a fasting sugar reading on one morning tells you far less than an HbA1c. You can have an acceptable fasting value and poor overall control if post meal spikes are high.
Reading the Numbers
Diagnostic thresholds are standard, and the treatment targets are not.
- Below 5.7 percent: normal
- 5.7 to 6.4 percent: prediabetes
- 6.5 percent or above: diabetes
Prediabetes is not a mild version of diabetes to be ignored. It is the stage at which intervention is most effective, and structured lifestyle change at this point prevents or substantially delays progression in a large proportion of people.
An HbA1c is included in most of our health check packages, and it is the single most useful screening test for anyone over forty with a family history or abdominal weight.
Why Targets Differ Between People
Patients often compare their numbers with others and worry unnecessarily. There is no single correct target.
- Under 6.5 percent: reasonable for a younger person, newly diagnosed, with no complications and no risk of hypoglycaemia
- Around 7 percent: the usual general target for most adults
- 7.5 to 8 percent: appropriate for older patients, those with limited life expectancy, established cardiovascular disease, or a history of severe low sugar episodes
Pushing an eighty year old on insulin toward 6.5 percent risks hypoglycaemia, and a serious low sugar episode causing a fall or a cardiac event does more harm than a slightly higher average.
Ask your doctor what your target is and why, rather than assuming a universal figure.
When HbA1c Can Mislead
Because it depends on red cell lifespan, several conditions distort the result.
- Anaemia: iron deficiency can raise HbA1c falsely, and this is very common in Indian women
- Recent blood transfusion or blood loss
- Haemoglobin variants such as thalassaemia traits and sickle cell, which are present in parts of India
- Chronic kidney disease
- Pregnancy, where HbA1c is not used for diagnosing gestational diabetes
If your HbA1c does not match your home glucose readings, one of these may be the reason. Fructosamine or continuous glucose monitoring can be used instead in these situations.
What Actually Moves the Number
The interventions with the largest effect are not the ones patients focus on most.
- Weight reduction: the most powerful single intervention. Substantial early weight loss can produce remission in newly diagnosed type 2 diabetes
- Reducing refined carbohydrate: portion of white rice, maida and sugar, rather than eliminating rice entirely
- Walking after meals: fifteen minutes after each main meal lowers the post meal spike measurably
- Resistance training: muscle is the main site of glucose disposal, and building it improves insulin sensitivity
- Sleep: short sleep worsens insulin resistance directly
- Medication taken consistently, which sounds obvious and is a frequent problem
Walking after meals is the most underused and most immediately effective habit available. Our dietetics team works within South Indian meal patterns rather than replacing them.
The Complications and Their Screening
Diabetes damages small and large blood vessels over years, silently. Screening finds the damage before it causes symptoms.
- Eyes: annual retinal examination. Diabetic retinopathy causes no symptoms until sight is threatened, and laser treatment works when applied early
- Kidneys: annual urine albumin and blood creatinine. Early kidney damage is reversible with the right medication
- Feet: annual examination for sensation and circulation, plus daily self inspection
- Heart: blood pressure, lipids and cardiovascular risk assessment
- Nerves: asking about numbness, tingling and burning
The annual eye check is the one most often skipped and the one that most directly prevents blindness. Our ophthalmology and nephrology departments provide this screening alongside diabetes clinics.
Medications Have Changed Substantially
Diabetes treatment is no longer only about lowering glucose. Several newer drug classes reduce cardiovascular and kidney events independently.
- Metformin: still first line for most, effective, inexpensive and well established
- SGLT2 inhibitors: lower glucose, and reduce heart failure hospitalisation and kidney disease progression
- GLP1 receptor agonists: lower glucose, produce substantial weight loss and reduce cardiovascular events
- DPP4 inhibitors: well tolerated, weight neutral
- Sulfonylureas: effective and inexpensive, but cause weight gain and hypoglycaemia
- Insulin: needed when other agents are insufficient, and not a sign of failure
If you have diabetes alongside heart failure, kidney disease or established cardiovascular disease, ask whether an SGLT2 inhibitor or GLP1 agonist is appropriate, since these carry benefits beyond glucose control.
Remission Is Possible
Type 2 diabetes has traditionally been described as progressive and permanent. That is no longer entirely accurate.
Substantial weight reduction, particularly within the first few years of diagnosis, can bring HbA1c below the diabetic range without medication. This is described as remission rather than cure, since the tendency remains and the condition can return with weight regain.
Remission is most achievable in people diagnosed recently, with shorter duration of diabetes, and who achieve significant sustained weight loss. It is less likely after many years or once insulin is required.
Do not attempt to stop medication independently. Any reduction must be supervised, with monitoring, through our diabetology department.
Know your HbA1c, know your personal target and why it is set there, and get the annual eye, kidney and foot checks. Walking after meals and modest sustained weight loss move the number more than any single tablet.
Our diabetes care service at T. Nagar provides structured management, and Dr. Jayaraman sees diabetes referrals.
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