Isolated HbA1c identifies a different subgroup of individuals with type 2 diabetes compared to fasting or post-challenge glucose in Asian Indians: The CARRS and MASALA studies

Diabetes Res Clin Pract. 2019 Jul;153:93-102. doi: 10.1016/j.diabres.2019.05.026. Epub 2019 May 28.


Aims: Guidelines recommend hemoglobin A1c (HbA1c) as a diagnostic test for type 2 diabetes, but its accuracy may differ in certain ethnic groups.

Methods: The prevalence of type 2 diabetes by HbA1c, fasting glucose, and 2 h glucose was compared in 3016 participants from Chennai and Delhi, India from the CARRS-2 Study to 757 Indians in the U.S. from the MASALA Study. Type 2 diabetes was defined as fasting glucose ≥ 7.0 mmol/L, 2-h glucose ≥ 11.1 mmol/L, or HbA1c ≥ 6.5%. Isolated HbA1c diabetes was defined as HbA1c ≥ 6.5% with fasting glucose < 7.0 mmol/L and 2 h glucose < 11.1 mmol/L.

Results: The age, sex, and BMI adjusted prevalence of diabetes by isolated HbA1c was 2.9% (95% CI: 2.2-4.0), 3.1% (95% CI: 2.3-4.1), and 0.8% (95% CI: 0.4-1.8) in CARRS-Chennai, CARRS-Delhi, and MASALA, respectively. The proportion of diabetes diagnosed by isolated HbA1c was 19.4%, 26.8%, and 10.8% in CARRS-Chennai, CARRS-Delhi, and MASALA respectively. In CARRS-2, individuals with type 2 diabetes by isolated HbA1c milder cardio-metabolic risk than those diagnosed by fasting or 2-h measures.

Conclusions: In Asian Indians, the use of HbA1c for type 2 diabetes diagnosis could result in a higher prevalence. HbA1c may identify a subset of individuals with milder glucose intolerance.

Keywords: Diagnostic criteria; HbA1c; Type 2 diabetes.

Publication types

  • Multicenter Study

MeSH terms

  • Asians
  • Blood Glucose / metabolism*
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Fasting
  • Female
  • Glycated Hemoglobin A / analysis
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • India / epidemiology
  • Male
  • Middle Aged


  • Blood Glucose
  • Glycated Hemoglobin A