Medical Bulletin 13/February/2026

HbA1c measures the glycation of hemoglobin and is commonly used to assess long-term blood sugar control. However, any condition that affects the quantity, structure, or lifespan of red blood cells can distort HbA1c readings. In India, where iron deficiency anemia and inherited blood disorders are prevalent in several regions, this limitation could affect millions.

Co-author Dr. Shashank Joshi from Mumbai highlighted that even in advanced urban hospitals, HbA1c results can be influenced by red blood cell variations. In rural and tribal regions, where anemia and genetic blood disorders are more common, discrepancies may be greater.

The review warns that sole reliance on HbA1c could delay diabetes diagnosis by up to four years in men with undetected G6PD deficiency, potentially increasing the risk of complications.

India currently has over 100 million people living with diabetes, with many cases remaining undiagnosed. The disease is no longer confined to affluent or urban populations; it is increasingly affecting younger adults and rural communities. Delayed or inaccurate diagnosis can lead to long-term damage to the heart, kidneys, eyes, and nerves.

Recommended Approach to Monitoring

The authors propose a resource-adapted framework for India:

• In low-resource settings: Use the oral glucose tolerance test (OGTT) for diagnosis and self-monitoring of blood glucose (SMBG) two to three times per week, combined with basic hematologic screening.

• In tertiary care settings: Combine standardized HbA1c testing with OGTT for diagnosis, and use continuous glucose monitoring (CGM) along with alternative markers such as fructosamine for monitoring.

• Where necessary, conduct iron studies, hemoglobin electrophoresis, and quantitative G6PD testing.

The review concludes that while HbA1c remains a valuable tool, it should not be used in isolation in India’s diverse population. A combined, context-specific approach to diagnosis and monitoring may help prevent delayed treatment and reduce diabetes-related complications.

REFERENCE: Samajdar, Shambo Samrat et al.; The limitations and fallacies of relying on glycosylated hemoglobin for diagnosing and monitoring diabetes in Indian populations; The Lancet Regional Health - Southeast Asia, Volume 0, Issue 0, 100724; https://doi.org/10.1016/j.lansea.2026.100724

58 Genetic Variants Linked to Anxiety Risk, Study Finds

Anxiety disorders are not driven by a single “anxiety gene,” but by dozens of subtle genetic variations spread across the human genome, according to a large international study published in Nature Genetics. Researchers identified 58 genetic variants associated with an increased risk of anxiety, pointing to 66 genes that may influence how the brain responds to stress and perceived threats.

The study was led by researchers from Texas A&M University and involved genetic data from 122,341 individuals diagnosed with major anxiety disorders and 729,881 individuals without such diagnoses. The team identified 58 independent genome-wide significant risk variants with strong biological support, substantially expanding understanding of anxiety’s genetic foundations.

Senior author Jack Hettema, Professor in the Department of Psychiatry and Behavioral Sciences at Texas A&M University, said anxiety disorders have long been recognized as heritable, but specific genetic links had remained unclear. “Anxiety disorders and their underlying sources of genetic risk have been understudied compared to other psychiatric conditions,” he noted, adding that the findings represent a major step forward.

Importantly, the study found a strong genetic overlap between anxiety and related traits such as depression, neuroticism, post-traumatic stress disorder (PTSD), and suicide attempts. This reinforces decades of clinical observations that these conditions frequently co-occur and may share common biological pathways.

Among the key findings was the involvement of genes linked to the regulation of gamma-aminobutyric acid (GABA), a brain chemical that helps calm nervous system activity. GABA pathways are already targeted by several anti-anxiety medications, lending biological credibility to the results and supporting long-suspected mechanisms underlying anxiety disorders.

However, researchers emphasized that genes alone do not determine whether someone will develop anxiety. Co-author Brad Verhulst highlighted that while the findings clarify biological vulnerability, lived experiences and environmental factors remain profoundly influential.

The authors said the newly identified genetic variants and pathways provide a roadmap for future research, potentially paving the way for earlier identification of vulnerable individuals and more personalized treatment strategies.

REFERENCE: Strom, N.I., Verhulst, B., Bacanu, SA. et al. Genome-wide association study of major anxiety disorders in 122,341 European-ancestry cases identifies 58 loci and highlights GABAergic signaling. Nat Genet (2026). https://doi.org/10.1038/s41588-025-02485-8

Infant Diet Quality Linked to Obesity Risk at Ages 6 and 9: Study

A large population-based study published in Maternal & Child Nutrition has found that poorer alignment with infant nutrition guidelines during the first year of life is associated with a higher risk of obesity in later childhood.

Researchers analyzed data from 12,848 children born in Iceland between 2009 and 2015, using linked national health registries. The study examined whether the Infant Diet Score (IDS)—a composite measure reflecting adherence to recommended infant feeding practices—was associated with obesity or overweight at ages 2.5, 4, 6, and 9 years.

The IDS includes six components: duration of exclusive breastfeeding, duration of any breastfeeding, timing of introduction of cow’s milk, timing of semi-solid foods, food group variety, and vitamin D supplementation. Children were divided into five quintiles based on their IDS, with higher scores indicating better alignment with infant nutrition guidelines.

At age six, 19.1% of children were classified as overweight and 8% as obese. By age nine, 23% were overweight and 14.6% were obese. The findings showed that children in the two lowest IDS quintiles had a significantly higher risk of obesity at ages six and nine compared to those in the highest quintile (IDS > 4.08). Specifically, children in the lowest quintiles had 37% to 58% greater odds of obesity in later childhood.

Associations were less consistent at younger ages. No clear links were observed between IDS and obesity or overweight at ages 2.5 and 4, except for one lower quintile at age 2.5. Additionally, IDS was not significantly associated with overweight (without obesity) at ages six and nine.

The results suggest that early-life dietary patterns may influence longer-term weight outcomes. However, as an observational registry-based study, the findings do not establish causation. The authors note that environmental, behavioral, and socioeconomic factors later in childhood may also shape obesity risk.

The study highlights the potential public health importance of supporting optimal nutrition during infancy as part of broader childhood obesity prevention strategies.

REFERENCE: Jonsdottir J, Thorisdottir B, Einarsdottir K, Thorsdottir I (2026). Infant Diet Is Associated With BMI Later in Childhood: A Nation-Wide Mother-Child Cohort Study in Iceland (ICE-MCH). Maternal & Child Nutrition, 22(1), e70165. DOI: 10.1111/mcn.70165, https://onlinelibrary.wiley.com/doi/10.1111/mcn.70165