Published: 2017-01-10

To establish the reference range of glycated hemoglobin

Nisha Dogra, Neeru Bhaskar, Rajesh Pandey, Suvarna Prasad, Jasbir Singh, Kuldip Singh Sodhi


Background: Diabetes mellitus (DM) has emerged as a major healthcare problem in India. There were an estimated 40 million persons with DM in India in 2007 and this number is predicted to rise to almost 70 million by 2025. It is estimated that every fifth person with diabetes will be an Indian. The objective of the present investigation was to establish the reference range for glycated hemoglobin (HbA1C) in healthy non-diabetic subjects in our hospital laboratory and compare it with the values reported by standard laboratories.

Methods: The study was conducted in the Department of Biochemistry, MMIMSR, Mullana (Ambala, Haryana). Total number of subjects was 50 (25 males, 25 females), aged 30 to 70 years. 2 ml of blood was collected from antecubital vein under aseptic conditions from each subject and put in EDTA vials. Hemolysed blood was estimated by semiautoanalyzer for HbA1C.

Results: In females, the levels were 6.50 ± 0.74 % while in males the levels were 6.27 ± 0.94 %. The overall range
in females was 4.8 - 7.56 % while in males it was 4.2 to 7.56 %. The values were comparable (p>0.05) with
those reported by standard laboratories, e.g. Dr. Lal PathLabs (<6%), Charak diagnostic (4.5-6.3%) and Mayo Clinic

Conclusion: Our laboratory levels of HbA1C are comparable with the reference range of different laboratories and hence suitable to be used as cut-offs while interpreting the results of patients with DM.



Diabetes mellitus, Glycated hemoglobin, HbA1C, Reference range

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Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimations and projections to the year 2010. Diabet Med. 1997;14(5):S1–S85.

Laakso M. Hyperglycemia and cardiovascular disease in type 2 Diabetes. Diabetes. 1999;48(5): 937–42.

Panzaram G. Mortality and survival in type 2 Diabetes mellitus. Diabetologia. 1990;39:1540–45.

Hanssen KF, Bangtad HJ, Brinchmann-Hansen O et al. Blood glucose control and diabetic microvascular complications: long term effects of near-normoglycaemia. Diabet Med. 1992; 9:697-705.

Fox CS, CoadyS S, Sorlie PD et al. Increasing cardiovascular disease burden due to diabetes mellitus: the Framingham Heart study. Circulation. 2007;115:1544-50.

Larsen ML, Horder M, Mogensen EF. Effect of long-term monitoring of glycosylated hemoglobin levels in insulin-dependent diabetes mellitus. N Engl J Med. 1990:323;1021-5, 1990.

Chandalia HB, Krishnaswamy PR. Glycated hemoglobin. Current Science. 2002(83) 12, 25.

Mahajan RD, Mishra B. Using Glycated Hemoglobin HbA1c for diagnosis of Diabetes mellitus:An Indian perspective. Int JBiol Med Res. 2011;2(2):508-12.

Nathan DM, Turgeon H, Regan S. Relationship between glycated haemoglobin levels and mean glucose levels over time. Diabetologi. 2007;50:2239-44.

David MN. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32:1327-34.

Sacks DB. Carbohydrates. In: Burtis CA, Ashwood ER, BrunsDE, eds. Tietz textbook of clinical chemistry and Molecular Diagnostics. 4th ed. New Delhi: Elsevier; 2008: 837-901.

Chung WW, Chua SS, Lal PS, Morisky DE. The Malaysian medication adherence scale (MALMAS): Concurrent validity using a clinical measure among people with Type 2 diabetes in Malaysia. PLoS one. 2015;10.

World Health Organization: Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus, 2011. WHO/NMH/CHP/CPM/11.1. Available from Accessed on 5/6/2015.