Glycated hemoglobin (HbA1c) and biofluid-based diagnosis in diabetes: A comprehensive review

The global rise in diabetes has fueled new developments in wearable devices. Diabetes, characterized by high glucose levels and impaired insulin secretion, causes a variety of complications. Diabetes rates in Southeast Asia and the Western Pacific are alarmingly high, with projections of a significant increase by 2045. The economic burden in the Asia-Pacific region is expected to reach USD 881.03 billion by 2030. Due to the unreliability of traditional blood glucose readings, glycated hemoglobin (HbA1c) has emerged as a stable biomarker that provides a consistent view of glycemic status over 2–3 months. Despite effective hospital-based HbA1c measurements, labor-intensive methods limit their use. Wearable systems that investigate glucose levels in alternative biofluids have promising potential for continuous monitoring, particularly in prediabetes cases. Current monitoring systems, while effective, are uncomfortable and expensive. This review examines diabetes diagnosis with HbA1c and biofluid-based sensors, focusing on blood-based evaluations and the complementary nature of glucose and HbA1c sensors. It emphasizes the critical importance of combining biofluid-based diagnosis with HbA1c measurement for effective diabetes management.