Single-panel cardiometabolic testing: an integrated, comprehensive view of type 2 diabetes (T2DM) comorbidities

About 1 in 10 Americans has diabetes (the vast majority of which is T2DM),¹ and more than half of all older adults in the US have 3 or more chronic conditions.²

With the increasing prevalence of diabetes, which research projects will increase by 54% between 2015 and 2030,³ insulin resistance and poor glycemic control is continuing to drive comorbid cardiometabolic disease.

Prevalent T2DM comorbidities—including cardiovascular disease (CVD), chronic kidney disease (CKD), metabolic dysfunction-associated steatotic liver disease (MASLD), and common endocrine disorders—often go undiagnosed and untreated.

By taking an integrated, holistic approach to testing for these chronic conditions, physicians can assess risk for multiple diseases earlier, providing more effective treatments.

In this article:

Clinical challenge | Why it matters | Ordering recommendations | Related tests | Next steps | Supporting resources

Clinical challenge: Testing for chronic conditions in isolation can create gaps in understanding downstream effects across organ systems

T2DM, CVD, CKD, MASLD (formerly known as nonalcoholic fatty liver disease or NAFLD), and common endocrine disorders share cardiometabolic risk factors and often go undiagnosed in early stages when intervention can be most effective.

Overlooking the interconnectedness of comorbid cardiometabolic conditions is a missed opportunity for early identification and intervention.

Shared cardiometabolic risk factors

Contributing to related conditions

Why it matters: Earlier identification of cardiometabolic conditions may help physicians prevent disease

Medical societies including the American Heart Association are recognizing the interrelated impacts of metabolic risk factors (ie, obesity and poor glycemic control), chronic kidney disease, and cardiovascular disease, and the gap in early screening, prevention, and management of these chronic conditions.^4,5

The American Heart Association recognizes the interconnections between cardiovascular-kidney-metabolic (CKM) risk factors, emphasizing the importance of early screening in disease prevention and management.

For patients with diabetes, additional testing is called for to screen for key comorbidities:

• Viral hepatitis (especially hepatitis C) has been shown to significantly increase the risk of developing T2DM, and a bidirectional metabolic relationship between the two conditions has been confirmed.⁶
• Diabetes increases susceptibility to tuberculosis and is linked to worse therapeutic outcomes due to impaired immune function. In a recent study, 21.42% of tuberculosis (TB) patients were found to have diabetes.⁷
• Exocrine pancreatic insufficiency is common among diabetes patients. A recent meta-analysis found that the pooled prevalence of EPI among T2DM patients is 22%, with 8% of those patients developing severe forms of EPI.⁸

Taking a more integrated approach with cardiometabolic testing can inform more timely, evidence-based treatment strategies to help prevent, reverse, or slow the progression of comorbidities.

Ordering recommendations: Comprehensive metabolic disease panel

Cardiometabolic assessment may be considered for patients annually. Testing is suitable for individuals who are affected by

• Obesity (BMI > 25)
• Hypertension
• History of gestational diabetes, preeclampsia, or PCOS
• Erectile dysfunction
• History of cardiovascular disease
• Metabolic and endocrine disorders that contribute to cardiometabolic risk, including
  • HbA1c ≥ 5.5%
  • Hyper-/hypothyroidism
  • Primary aldosteronism

Additional factors for consideration include age (> 45 male, > 50 female), family history, and sedentary lifestyle. End organ disease assessment can be followed by disease-specific marker investigation.

Recommended test: Cardiometabolic Disease Assessment (CMDA) panel

Test code: 14273

CPT code(s):

80061,* 82172,* 83036,* 83525, 84681, 82570, 82043, 80053, 85049,* 84443*

*CPT Code is subject to a MEDICARE LIMITED COVERAGE POLICY and may require a signed ABN when ordering.

Clinical Significance

This panel combines tests used in the diagnosis and management of cardiometabolic disease elements, including metabolic syndrome, prediabetes, diabetes, thyroid conditions, kidney, fatty liver, and cardiovascular disease risk. It can help identify the presence and progression of cardiometabolic disease by assessing metabolic state and downstream effects on the liver, kidneys, and heart.

Testing considerations

Patient preparation:
Patient should be fasting 9-12 hours

Tests included in panel

Related tests for potential correlated conditions:

Hepatitis

• HBV Triple Screen Panel with Reflexes: Test code 39170
  Panel components may be ordered separately. Includes Hepatitis B Surface Antigen with Reflex confirmation (498); Hepatitis B Core Antibody, Total, with Reflex to IgM (37676); and Hepatitis B Surface Antibody Immunity, Quantitative (8475).
• Hepatitis C Antibody with Reflex to HCV, RNA, Quantitative, Real-Time PCR: Test code 8472

Tuberculosis

• TSPOT^®.TB: Test code 37737
• QuantiFERON®-TB Gold Plus, 1 Tube: Test code 36970

Exocrine pancreatic insufficiency (EPI)

• Pancreatic Elastase-1: Test code 14693

Next steps: Appropriate treatment protocols and ongoing monitoring

Patients should be treated in accordance with the recommended protocols for each of their respective diagnoses. For optimal outcomes, rigorous ongoing monitoring for condition management and interrelated effects is recommended.

Supporting resources