Understanding the Pre-Diabetes/Diabetes Patient
According the Center for Disease Control and Prevention (CDC), more than 100 million U.S. adults are now
living with diabetes or prediabetes. This statistic is staggering and essentially means that 1 in 3 persons in the
U.S. are effected by some form of insulin/glucose imbalance. This disorder is believed to be responsible for the
very large portion of the U.S. population now considered obese. Current statics show that ~42% of men and
women over the age of 40 are obese. Even more concerning is that by 2020, it is believed that three out of
every four Americans with be considered overweight.
Diabetes risk is defined as glucose levels >100mg/dL fasting or an A1c >5.7%. The problem with these mark-
ers is that insulin resistance, the true driver of prediabetes and diabetes in the world today, starts years if not
decades before. Current routine testing is not sufficient for identifying those patients with these imbalances and
by the time there is an issue, it is very difficult to slow down or even stop the progression of the disease.
Better Testing, Better Outcomes:
There are multiple other modalities and screening tests that can be performed to help clinicians
understand and better determine who is at greatest risk for developing prediabetes and diabetes. Cholesterol
testing that is unaffected by triglyceride levels is a start in better characterizing those at risk for diabetes.
Developed at the University of Alabama at Birmingham (UAB), the VAP Cholesterol test was designed to over-
come the mathematical and clinical limitations of the routine cholesterol test. These improvements are:
Direct measurements of all results utilizing no calculations
Can be performed on non-fasting patients
Provides all cholesterol risk factors outlined by all major lipid guidelines
In addition to better cholesterol testing, there are several tests that can be performed to help clinicians under-
stand who is at risk for developing insulin resistance and diabetes. These include:
It is well established that many clinicians track disease states with a certain battery of tests based on their clini-
cal judgment. We can capture this clinical judgement in the form of patient specific profiles that you create and
design per your patient population needs. This insures that all testing is ordered every time and nothing is for-
gotten or left off for your patients.
There are times when routine testing is not descriptive enough to understand what is happened to a patient.
While there are industry established reflex profiles that are available to all clinicians, there may be some reflex
profiles that you want uniquely for you and your practice. We can capture these unique reflex profiles and have
those available on your requisition for ease of use.
Our lab is devoted to being the experts in clinical care for those patients over the age of 50. We specialize in
services that fit this unique subset of the population and aim to provide top level testing and services to your
practice to serve your patients. Let us be your lab of choice when you need better testing. Our goal is your
goal...helping the patient achieve better outcomes.
LMG Lab Medical Group /VAP Diagnostics Laboratory
25901 Commercentre Drive, Lake Forest, CA 92630
In addition to better cholesterol testing, there are services that can improve a clinician’s ability to determine who is at risk
for diabetes and cardiovascular disease. For example, specific testing now available:
Cystatin C is indicated for patients who are at risk for renal disease. Patient who are insulin resistant or diabetic are at risk for renal disease. Cystatin C overcomes limitations seen in routine eGFR testing using serum creatinine. Cystatin C can detect early signs of disease, giving clinicians the opportunity to intervene earlier and stop the progression.
HbA1c is gold standard in managing diabetes and diabetes risk. HbA1c measures the 3 month average glucose in a person body.
Normal is <5.7%, Prediabetes is 5.7% - 6.4%, Diabetes is >6.5%
Insulin is often ordered for diabetics to see how much insulin the pancreases is still producing and whether additional exogenous (external) insulin may be required to maintain healthy blood glucose levels. Also, mildly elevated fasting blood insulin levels are an indicator of prediabetes and risk for type 2 diabetes.
1,5-Anhydroglucitol (1,5AG) is a naturally occurring sugar that in normal people is easily kept in the body in high levels. The low serum levels indicates that over the last 2 weeks the patient has experienced high glucose spikes which are treated differently than elevated A1c levels. Spikes in glucose require postprandial agents and therapy as opposed to basal acting agents that manage fasting blood sugar levels.
GGT is a not only found in the liver but also in the kidney, lung, pancreas, and vascular endothelium and is a sensitive indicator of hepatic cell inflammation and hepatic intracellular triglyceride accumulation as seen in patients with diabetes. Elevated levels would lead to more aggressive reductions in triglycerides by way of diet and lifestyle modifications and pharmacotherapy.
hsCRP is often ordered in diabetic and CVD risk patients for several reasons. Primary reason is that elevated hsCRP is a huge risk for CVD and death from CVD. Patients with diabetes or CVD risk factors who do not manage their medications and lifestyle well will have elevated hsCRP levels and those who live with chronic elevations over a long period of time are at significant risk for MI or death by MI.
Uric Acid has been used as an early indicator of kidney disease in patients with diabetes well before the patient experienced elevated levels of urine albumin. Also, patients who have slightly elevated levels are at very high risk for developing diabetes and mildly elevated levels of uric acid can lead to hypertension.
ApoB/ApoA1 are the functional proteins found on all nonHDL particles and HDL particles respectively. Is the strongest indicator of CVD risk than any other ratio use in CVD risk assessment. Often in patients with diabetes, these apolipoprotein better characterize risk than traditional lipid parameters.
LpPLA2 is a marker of vulnerable plaque in the artery wall. The plaque that is vulnerable is considered rupture prone. High levels of LpPLA2 is an indication that a patient is at risk for plaque rupture which can lead to a heart attack or stroke.
Vitamin D is involved in over 2000 metabolic reactions and low levels have been shown to increase risk for hypertension, diabetes, CVD, MI, depression, and a myriad of other diseases. Routine assessment of this vital hormone is important part of disease risk reduction and general well-being.