From the Guidelines
For a 36-year-old female with a new diagnosis of diabetes, the initial laboratory workup should include a hemoglobin A1C test, fasting plasma glucose, comprehensive metabolic panel, lipid panel, urinalysis, urine albumin-to-creatinine ratio, and thyroid function tests, as recommended by the most recent guidelines 1.
Necessary Lab Tests
The following lab tests are necessary for a comprehensive evaluation:
- Hemoglobin A1C test to assess average blood glucose levels over the past 2-3 months
- Fasting plasma glucose to confirm the diagnosis
- Comprehensive metabolic panel to evaluate kidney and liver function
- Lipid panel (total cholesterol, LDL, HDL, triglycerides)
- Urinalysis to check for protein or ketones
- Urine albumin-to-creatinine ratio to assess for early kidney damage
- Thyroid function tests (TSH, free T4) to check for coexisting thyroid disorders
Additional Recommendations
Additional recommendations include:
- Testing for glutamic acid decarboxylase (GAD) antibodies and islet cell antibodies to distinguish between Type 1 and Type 2 diabetes, especially given the patient's relatively young age
- Baseline electrocardiogram to assess cardiovascular health
- Referral for an eye examination to establish a baseline for retinopathy screening These tests and recommendations are based on the latest guidelines and evidence, including those from the American Diabetes Association 1 and other reputable sources.
Prioritization of Tests
The prioritization of these tests is based on the need to determine the type of diabetes, assess for complications, guide treatment decisions, and establish baseline values for future monitoring of disease progression and treatment effectiveness. The most recent and highest quality studies, such as those published in 2023 1, provide the best evidence for these recommendations.
From the Research
Necessary Lab Tests for Diabetes Mellitus Diagnosis
The following lab tests are necessary for a 36-year-old female with a new diagnosis of diabetes mellitus (DM):
- Hemoglobin A1c (HbA1c) test to monitor glucose homeostasis and identify risk for diabetes 2, 3
- Plasma glucose determinations, such as fasting plasma glucose or 2-hour postglucose-load plasma glucose, to confirm the diagnosis of diabetes 3
- Lipid profile, including HDL and LDL cholesterol, triglycerides, and apolipoprotein AI and B, to assess the risk of cardiovascular disease 2, 4
- Uric acid test to evaluate the risk of hyperuricemia and its association with HbA1c levels 2
- C-reactive protein (CRP) test to assess low-grade inflammation and its association with HbA1c levels 2
- Microalbuminuria test to monitor kidney function and detect early signs of diabetic nephropathy 5
Additional Considerations
- The HbA1c test should be used in combination with plasma glucose determinations to confirm the diagnosis of diabetes 3
- The lipid profile and liver function tests, such as fatty liver index (FLI) and ultrasound scan of the liver, should be performed to assess the risk of liver steatosis and cardiovascular disease 4
- The BARD score, which includes body mass index, aspartate aminotransferase/alanine aminotransferase ratio, and diabetes, should be calculated to evaluate the risk of liver fibrosis 4