Haemoglobin A1c (HbA1c) : clinical relevance, history, and role in diabetes mellitus management – a South African perspective

Abstract

BACKGROUND : Diabetes mellitus (DM) is a growing health challenge in South Africa, with an increasing prevalence driven largely by urbanisation and lifestyle changes. Haemoglobin A1c (HbA1c) has emerged as a pivotal biomarker for diagnosing and monitoring diabetes. Its clinical utility is well established globally, yet its optimal use in the South African healthcare landscape remains an area of interest. This article provides a comprehensive review of HbA1c, outlining its historical discovery, biochemical basis, clinical applications, and interpretation challenges. Emphasis is placed on its role in South Africa, where access to laboratory testing and point-of-care diagnostics influences diabetes care. METHODS : A literature review was conducted using PubMed, Google Scholar, and local healthcare databases to evaluate HbA1c’s effectiveness in DM diagnosis and monitoring. International and South African guidelines were analysed to assess the standardisation and applicability of HbA1c testing in diverse populations. RESULTS : HbA1c is vital in diabetes management, though its accuracy may be affected by haemoglobinopathies, ethnicity, age, and medical conditions. Technological advances, such as point-of-care testing (POCT), have improved accessibility, particularly in underserved areas. Personalised HbA1c targets are increasingly recommended to enhance patient-centred care. CONCLUSION : While HbA1c is a valuable diagnostic and monitoring tool, healthcare professionals (HCPs) must be aware of its limitations in specific populations. Expanding access to HbA1c testing and integrating individualised glycaemic targets can improve diabetes management outcomes in South Africa.