What laboratory tests are recommended for monitoring Diabetes Mellitus (DM)?

From the Guidelines

Regular blood work for monitoring diabetes should include hemoglobin A1C (HbA1C) testing every 3-6 months, which measures average blood glucose levels over the past 2-3 months, with a target generally below 7% for most adults with diabetes, as recommended by the most recent guidelines 1.

Key Laboratory Tests for Diabetes Monitoring

The following tests are essential for monitoring diabetes:

• Hemoglobin A1C (HbA1C) testing every 3-6 months to assess long-term glucose control
• Fasting blood glucose tests to assess immediate glucose control, with targets typically between 80-130 mg/dL before meals
• Comprehensive metabolic panel annually to evaluate kidney function, electrolytes, and liver function
• Lipid profiles (total cholesterol, LDL, HDL, triglycerides) annually to monitor cardiovascular risk
• Urine albumin-to-creatinine ratio testing yearly to detect early kidney damage

Additional Considerations

For patients on certain medications like metformin, vitamin B12 levels may need monitoring, while those on insulin or sulfonylureas should have their blood glucose checked more frequently to avoid hypoglycemia, as suggested by previous guidelines 1. However, the most recent and highest quality study 1 provides the most up-to-date recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus.

Frequency and Timing of Tests

The frequency and timing of these tests may vary depending on the individual patient's needs and treatment plan, but hemoglobin A1C testing every 3-6 months is a crucial component of diabetes monitoring 1.

From the FDA Drug Label

As with all insulin therapy, the therapeutic response to LEVEMIR should be monitored by periodic blood glucose tests. Periodic measurement of HbA1c is recommended for the monitoring of long-term glycemic control.

The recommended laboratory tests for monitoring Diabetes Mellitus (DM) are:

• Periodic blood glucose tests
• Periodic measurement of HbA1c for long-term glycemic control 2

From the Research

Laboratory Tests for Monitoring Diabetes Mellitus (DM)

The following laboratory tests are recommended for monitoring Diabetes Mellitus (DM):

• Hemoglobin A1c (HbA1c) is considered the standard measure of long-term glycemic control 3
• Self-monitoring of blood glucose (SMBG) complements HbA1c by providing real-time blood glucose data 3
• Fasting plasma glucose (FPG) levels, with a diagnostic cutoff of 126 mg/dL (7.0 mmol/L) 4
• Oral glucose tolerance test (OGTT), with a 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or more 4
• Urine glucose testing, although it is dependent on the patient's individual renal threshold and can only detect glucose concentrations above this threshold 3
• Microalbuminuria testing, which indicates early, reversible, diabetic nephropathy 4
• Random urine albumin-creatinine ratio, which is a convenient and effective screening test for microalbuminuria 4

Diagnostic Criteria

The diagnostic criteria for Diabetes Mellitus (DM) include:

• HbA1c level greater than or equal to 6.5% 5, 6
• Fasting plasma glucose level of 126 mg/dL (7.0 mmol/L) or more 4
• 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or more during an OGTT 4
• Random plasma glucose level of 200 mg/dL (11.1 mmol/L) or more 4

Considerations for Test Selection

When choosing a test for monitoring DM, considerations should include:

• The advantages and disadvantages of each test 7
• The possibility of performing different tests at once 7
• The need to simplify screening tests for type 2 diabetes mellitus (T2DM) so patients can be identified earlier and more efficiently 6
• The logistical advantages of using HbA1c, such as not requiring fasting and reflecting longer-term glycaemia 6