Screening for diabetes risk

At Quest Diagnostics, we believe that offering hemoglobin A1c (HbA1c) testing as part of your workplace screening program is a wellness best practice to improve population health. Screening for HbA1c enhances the identification of those at risk for prediabetes, enabling those at risk to take action to improve health before they become high-cost claimants. If an employer only screens for glucose as part of an employer-sponsored wellness screening, they may be missing an important opportunity to give employees insight into their prediabetes or type 2 diabetes risk.

In order to drive participation in wellness screening programs, convenience is key. For many employers, adding convenience to a program means multiple screening options, including on-site events and convenient local Quest Diagnostics Patient Service Centers (PSCs).

While all PSCs complete screenings using the venipuncture collection method, many employers use fingerstick screenings (also called point-of-care testing) at on-site events. Fingerstick screenings enable participants to leave their wellness screenings with results in hand. Yet Quest does not include HbA1c testing in fingerstick screenings, due to current usage regulations and recommendations for point-of-care devices.

If you’re an employer who has seen the rise of the type 2 diabetes epidemic firsthand through the declining health of your employee population, and the consistent increases in your healthcare spend, it may be worth considering other options besides a fingerstick-only screening program. Same-day results may be convenient, but early prevention of disease may be worth more. 

Fingerstick screenings have grown in popularity because they give individuals results almost immediately. Fingerstick screenings attempt to identify the presence of possible conditions or disease risks, but they should not be a replacement for a physician’s care. As such, fingerstick analyzers (the machines used to analyze the 4 drops of blood for a fingerstick screening) are not designed to measure HbA1c for the purpose of alerting individuals to diabetes risk.

Fingerstick A1c tests are meant to monitor people who have previously been diagnosed with diabetes,³ not assess the risk of people without a diagnosis. Based on that guidance, Quest does not use fingerstick devices to measure A1c for screening purposes. 

At Quest Diagnostics, we offer HbA1c testing using the venipuncture collection method or our collection card testing option. Collection cards use a fingerstick collection to obtain the sample, but the analysis is completed in a Quest Diagnostics laboratory rather than a point-of-care device. 

For any employer looking to secure the benefits gained with HbA1c testing— such as a population more aware of their diabetes risk coupled with reduced healthcare spending—we suggest using the venipuncture collection method for on-site events. It is also possible to add the collection card option to on-site fingerstick events. Not only will this give you the ability to test your population for HbA1c at on-site events, but your program will see many benefits.

• Venipuncture screening opens your program to a broader test menu, allowing you to add additional tests in the future to screen for other diseases, like eGFR for kidney function, or hsCRP for heart disease. These additional tests also allow your organization to direct the right people into the right care, to make sustainable lifestyle changes. Adding collection cards to on-site fingerstick events also broadens the available test menu with select additional tests including HbA1c and prostate-specific antigen (PSA).
• Venipuncture and collection card screenings are more valued by physicians as the specimens are tested in a lab. This means that when participants take their results to a primary care physician, the results are seen as clinical by the physician. Participants will then be able to have a meaningful discussion with their doctor about their numbers and health risks and how to make any necessary lifestyle changes.
• Venipuncture screening at on-site events gives those who screen on site the same experience as participants who screen remotely at a PSC.

The overall goal of employee wellness screening programs should be to help individuals identify their health risks and take action to reduce these risks. This may lead to savings for both the individual and the organization. HbA1c testing is the an effective way to identify risk for one of the most costly conditions: type 2 diabetes.