India has emerged as the diabetes capital of the world with incidence steadily on the rise over the last three decades. The prevalence of diabetes in India stood at 8.9% in 2019 with more than 77 million people with diabetes. As per a recent study done by ICMR, India currently has 101 million people living with Diabetes and an estimated 136 million people have prediabetes. It is also estimated that approximately 43.9 million people are undiagnosed and account for 57% of adults. This calls for amplified diabetes screening and identifying individuals who are at high risk for diabetes; i.e. those who are prediabetes. Undiagnosed diabetes further exacerbates the risk of diabetes related complications resulting in increased diabetes related deaths. Ahead of World Diabetes Day, Agilus Diagnostics, India’s largest diagnostic network* conducted a retrospective data study on samples that were tested for HbA1c and Fasting Blood Glucose across its laboratory network for a period of five years (Between January 2018 to December 2022).
Why HbA1c:
HbA1c reflects average plasma glucose over the previous 8 to 12 weeks. It can be performed at any time of the day and does not require any special preparation such as fasting. These properties have made it the preferred test for assessing glycaemic control in people with diabetes. More recently, there has been substantial interest in using it as a diagnostic test for diabetes and as a screening test for persons at high risk of diabetes.
For people without diabetes, the normal range for the HbA1c level is less than 5.7%. HbA1c levels between 5.7% and 6.4% mean one has a higher chance of getting diabetes (pre-diabetes). Levels of 6.5% or higher mean one has diabetes. Diabetics who keep their hemoglobin A1c levels close to 7% have a much better chance of delaying or preventing diabetes complications than people with levels 8% or higher.
Why Fasting Blood Glucose?
This test measures blood glucose levels after an overnight fast of 8 to 12 hours (not eating). A fasting blood sugar level of 99 mg/dL or lower is normal, 100 to 125 mg/dL indicates that one has prediabetes, and 126 mg/dL or higher indicates diabetes.
Speaking on the all India study, Dr Avinash Phadke, President & Mentor, Agilus Diagnostics said “It is alarming that nearly half of our adult population is diabetic and a large number of population is also pre diabetic. Since pre-diabetes is reversible, urgent action is needed to delay or prevent the onset of diabetes. Likewise, there has been a consistent increase in the prevalence of gestational diabetes over time. Evidence-based lifestyle modifications, such as proper diet, exercise, sleep hygiene, and weight control, can not only help prevent diabetes but also enhance an individual’s general health. Stress levels have increased across age groups and this risk factor is often disregarded. For overall wellbeing, managing stress through self-care practices is equally crucial. Awareness regarding diabetes, its risk factors and complications is still considerably low in India. Inadequate access to healthcare settings and affordable medicines pose a challenge in prevention and management of diabetes. Another important aspect to consider is a multi-sectoral approach and population surveillance data that can truly control the diabetes epidemic in the country as well as reduce diabetes related complications.”
Key Findings from the data study
- A total of 32, 27, 168 samples were analyzed for HbA1c. Of these, 40.92% tested positive for diabetes, 22.25% were found to be pre-diabetic while 36.83% had normal HbA1c levels.
- A total of 61, 10,479 samples were analyzed for HbA1c. Of these, 28.67% tested positive for diabetes, 28.51% were found to be pre-diabetic while 42.82% had normal fasting glucose levels.
- In the age group between 46 to 60 years amongst both females and males, almost half of the samples tested were diabetic
- 55% samples from female and 58% samples from male in the age group 61 to 85 tested for HbA1c had abnormal HbA1C levels.
- 36.98% samples from female and 39.32% samples from male in the age group 61 to 85 tested for fasting blood glucose had abnormal levels.
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| HbA1c Data Analysis Trend in Females | ||||||||
| Age Group | Normal | Pre Diabetes | Diabetes Mellitus | Total | Normal (in %) | Pre Diabetes (in %) | Diabetes Mellitus (in %) | |
| 0-15 | 8474 | 1454 | 2602 | 12530 | 67.63 | 11.60 | 20.77 | |
| 16-30 | 152117 | 19091 | 14643 | 185851 | 81.85 | 10.27 | 7.88 | |
| 31-45 | 249395 | 82241 | 91621 | 423257 | 58.92 | 19.43 | 21.65 | |
| 46-60 | 128375 | 128472 | 234410 | 491257 | 26.13 | 26.15 | 47.72 | |
| 61-85 | 66441 | 105287 | 212304 | 384032 | 17.30 | 27.42 | 55.28 | |
| 85+ | 1828 | 2308 | 2935 | 7071 | 25.85 | 32.64 | 41.51 | |
| Total | 606630 | 338853 | 558515 | 1503998 | 40.33 | 22.53 | 37.14 | |
| HbA1c Data Analysis Trend in Males | |||||||
| Age Group | Normal | Pre Diabetes | Diabetes Mellitus | Total | Normal (in %) | Pre Diabetes (in %) | Diabetes Mellitus (in %) |
| 0-15 | 14139 | 2162 | 8684 | 24985 | 56.59 | 8.65 | 34.76 |
| 16-30 | 114434 | 17439 | 17774 | 149647 | 76.47 | 11.65 | 11.88 |
| 31-45 | 234457 | 103504 | 151168 | 489129 | 47.93 | 21.16 | 30.91 |
| 46-60 | 134041 | 128782 | 291692 | 554515 | 24.17 | 23.22 | 52.60 |
| 61-85 | 82355 | 123994 | 287703 | 494052 | 16.67 | 25.10 | 58.23 |
| 85+ | 2470 | 3403 | 4969 | 10842 | 22.78 | 31.39 | 45.83 |
| Total | 581896 | 379284 | 761990 | 1723170 | 33.77 | 22.01 | 44.22 |
| Grand Total | 1188526 | 718137 | 1320505 | 3227168 | 36.83 | 22.25 | 40.92 |
| Fasting Blood Glucose Trends in Females | ||||||||
| Age Group | Normal | Pre Diabetes | Diabetes Mellitus | Total | Normal (in %) | Pre Diabetes (in %) | Diabetes Mellitus (in %) | |
| 0-15 | 16510 | 2062 | 1101 | 19673 | 83.92 | 10.48 | 5.60 | |
| 16-30 | 321677 | 53356 | 19749 | 394782 | 81.48 | 13.52 | 5.00 | |
| 31-45 | 469754 | 185721 | 135812 | 791287 | 59.37 | 23.47 | 17.16 | |
| 46-60 | 312735 | 288163 | 325437 | 926335 | 33.76 | 31.11 | 35.13 | |
| 61-85 | 216255 | 231884 | 262934 | 711073 | 30.41 | 32.61 | 36.98 | |
| 85+ | 4963 | 3601 | 3277 | 11841 | 41.91 | 30.41 | 27.68 | |
| Total | 1341894 | 764787 | 748310 | 2854991 | 47.00 | 26.79 | 26.21 | |
| Fasting Blood Glucose Trends in Males | ||||||||
| Age Group | Normal | Pre Diabetes | Diabetes Mellitus | Total | Normal (in %) | Pre Diabetes (in %) | Diabetes Mellitus (in %) | |
| 0-15 | 20834 | 3154 | 5881 | 29869 | 69.75 | 10.56 | 19.69 | |
| 16-30 | 262323 | 66104 | 25251 | 353678 | 74.17 | 18.69 | 7.14 | |
| 31-45 | 457207 | 271314 | 222718 | 951239 | 48.06 | 28.52 | 23.41 | |
| 46-60 | 288505 | 328693 | 393712 | 1010910 | 28.54 | 32.51 | 38.95 | |
| 61-85 | 239358 | 301935 | 350773 | 892066 | 26.83 | 33.85 | 39.32 | |
| 85+ | 6690 | 5915 | 5121 | 17726 | 37.74 | 33.37 | 28.89 | |
| Total | 1274917 | 977115 | 1003456 | 3255488 | 39.16 | 30.01 | 30.82 | |
| Grand Total | 2616811 | 1741902 | 1751766 | 6110479 | 42.82 | 28.51 | 28.67 |
A note: This report has been prepared on the basis of a retrospective data mining done on results of tests done for HbA1c and Fasting Blood Sugar. As an advanced Clinical Reference Laboratory, Agilus receives samples both for screening and diagnostic purpose. Hence it is expected that there may be a bias in the statistical analysis of tests done for HbA1c levels and Fasting Blood Glucose. Both tests are considered for a screening and monitoring purpose which adds to the bias of the study. However, the analysis is relevant to the ‘diabetic’ cohort and those who are at high risk to develop diabetes (prediabetes).
