Test Center

My Recent Searches

  • No Recent Search.

My Tests Viewed

  • No Test Viewed.

Diabetes, Newly Diagnosed and Monitoring Panel

Diabetes, Newly Diagnosed and Monitoring Panel

Test Summary

Diabetes, Newly Diagnosed and Monitoring Panel

  

Clinical Use

  • Establish baseline measurements for patients recently diagnosed with diabetes mellitus
  • Monitor patients with diabetes mellitus

Clinical Background

Diabetes mellitus is characterized by high glucose levels in blood and urine stemming from defects in insulin secretion, insulin action, or both. High blood glucose causes abnormalities of carbohydrate, fat, and protein metabolism. An estimated 415 million people worldwide have diabetes.1 In the United States, the prevalence is 12.8% (approximately 29 million persons) in individuals 20 to 79 years of age1; 28% of these are undiagnosed.1

Chronically high blood glucose causes vascular damage and impacts organs including the eyes, kidney, heart, liver, and nervous system.2 Long-term complications of diabetes include retinopathy, nephropathy and renal failure, atherosclerotic cardiovascular disease (CVD), nonalcoholic fatty liver disease (NAFLD), and neuropathy.2,3 High blood pressure, dyslipidemia, and NAFLD are highly prevalent.2,3 Diabetes mellitus is diagnosed based on the presence of elevated glycated hemoglobin (HbA1c), elevated fasting plasma glucose (FPG), or elevated 2-hour plasma glucose after a 75-g glucose load.2

The American Diabetes Association (ADA) recommends that a comprehensive laboratory evaluation for diabetes include HbA1c, fasting lipid profile, liver function tests, urine albumin and albumin-to-creatinine ratio, and serum creatinine and estimated glomerular filtration rate (eGFR).2 The ADA further recommends a thyroid stimulating hormone (TSH) test for patients with type 1 diabetes and women considering pregnancy.2

The ADA recommends comprehensive laboratory testing initially with the frequency of follow-up testing dependent upon the patient and component.2 HbA1c testing is recommended at least 2 times a year for patients meeting their treatment goal and 4 times a year for those who are not meeting their goals or have changed their therapy.2 The ADA further recommends at least annual monitoring of dyslipidemia and albuminuria for all patients with diabetes.2

The Diabetes, Newly Diagnosed and Monitoring Panel enables a comprehensive laboratory evaluation of patients with diabetes in accordance with ADA guidelines. Components of the panel are listed in the Table and can be ordered separately.

Table. Diabetes, Newly Diagnosed and Monitoring Panel Components and Methods

Test Code

Test Name

Method

375

Creatinine

Spectrophotometry

483

Glucose

Spectrophotometry

496

Hemoglobin A1c

Immunoturbidimetry

10256

Hepatic Function Panela

Includes: alanine aminotransferase (ALT; 823), albumin (223), albumin/globulin ratio (calculated), alkaline phosphatase (234), aspartate aminotransferase (AST; 822), direct bilirubin (285), globulin (calculated), indirect bilirubin (calculated), total bilirubin (287), and total protein (754).

Spectrophotometry

7600

Lipid Panela

Includes: cholesterol/HDL ratio (calculated), high-density lipoprotein (HDL) cholesterol (608), low-density lipoprotein (LDL) cholesterol (calculated), non-HDL cholesterol (calculated), total cholesterol (334), and triglycerides (896). If the triglyceride level is >400 mg/dL, a direct LDL (8293) will be performed at an additional charge

Spectrophotometry

6517

Microalbumin, Random Urine with Creatinine

Turbidimetry

a

Components of the panel can be ordered separately.

Individuals Suitable for Testing

  • Individuals with diabetes mellitus

Method

The method used for each component in the panel is shown in the Table.

Interpretive Information

An HbA1c level of ≥6.5%, FPG of ≥126 mg/dL, or 2-hour plasma glucose of ≥200 mg/dL after an oral glucose load of 75 g glucose is consistent with a diagnosis of diabetes mellitus.2 In patients with diabetes, the HbA1c should be maintained at ≤7%, as this level is associated with a reduction in microvascular disease.2 Blood glucose targets are individualized based on duration of diabetes, age, life expectancy, comorbidities, and the presence of CVD. Preprandial glucose levels of 80 to 130 mg/dL and postprandial (1 to 2 hours after the beginning of a meal) levels of <180 mg/dL are suggested.2

A urine albumin level of <30 µg/mg creatinine is normal, 30-299 µg/mg is high, and ≥300 µg/mg is very high (>300 µg/mg is called overt nephropathy).2,4 Even patients with a urine albumin of <30 µg/mg creatinine should be assessed annually, as values as low as 10 µg/mg creatinine are associated with increased cardiovascular risk.5 An eGFR of <60 mL/min, even in the presence of low or no albuminuria, is an independent cardiovascular risk factor.2,5

HDL cholesterol values <40 mg/dL (<50 mg/dL in women) are low, whereas triglycerides >150 mg/dL and LDL cholesterol >100 mg/dL are elevated.2,6 In individuals with overt CVD, the LDL cholesterol goal is <70 mg/dL,7 although the use of specific lipid goals is controversial.8 ADA recommends statin and lifestyle therapy for all patients with diabetes if they also have overt CVD or LDL cholesterol >100 mg/dL or one or more other CVD risk factors (family history of premature CVD, chronic kidney disease, hypertension, smoking, or albuminuria).2

Elevated liver function tests are nonspecific and may be an indication of NAFLD, cirrhosis, or other hepatic or systemic pathology; they should be interpreted in light of other clinical and laboratory findings.

References

  1. International Diabetes Federation. IDF Diabetes, 7 ed. Brussels, Belgium: International Diabetes Federation, 2015. http://www.diabetesatlas.org. Accessed January 5, 2017.

  2. American Diabetes Association. Standards of medical care in diabetes—2017. Diabetes Care. 2017;40(suppl 1):S1-S120.

  3. Leite NC, Villela-Nogueira CA, Cardoso CR, et al. Non-alcoholic fatty liver disease and diabetes: from physiopathological interplay to diagnosis and treatment. World J Gastroenterol. 2014;20:8377-8392.

  4. Thorp ML. Diabetic nephropathy: common questions. Am Fam Physician. 2005;72:96-99.

  5. Sacks DB, Arnold M, Bakris GL, et al. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care. 2011;34:e61-99.

  6. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497.

  7. Jellinger PS, Smith DA, Mehta AE, et al. American Association of Clinical Endocrinologists' guidelines for management of dyslipidemia and prevention of atherosclerosis. Endocr Pract. 2012;18 Suppl 1:1-78.

  8. Robinson JG, Stone NJ. The 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk: a new paradigm supported by more evidence. Eur Heart J. 2015;36:2110-2118.


 Content reviewed 02/2017
 

top of page

 

* The tests listed by specialist are a select group of tests offered. For a complete list of Quest Diagnostics tests, please refer to our Directory of Services.