Which laboratory tests should be ordered for a routine three‑month diabetes follow‑up?

Routine 3-Month Diabetic Blood Work

For routine three-month diabetes follow-up, you should order HbA1c as the primary test, and include a lipid panel (at minimum annually) and urine albumin-to-creatinine ratio (at minimum annually) to monitor for complications. 1

Core Laboratory Tests

HbA1c (Every 3 Months)

• HbA1c should be measured routinely every 3 months until acceptable glycemic targets are achieved, then no less than every 6 months. 1
• This is the single most important test for your 3-month visit, as it reflects average glucose control over the preceding 2-3 months and directly correlates with risk of diabetic complications. 1
• Only use NGSP-certified methods performed at CLIA-certified laboratories. 1
• Target HbA1c <7% (<53 mmol/mol) for most nonpregnant adults, though higher targets are appropriate for patients with limited life expectancy, extensive comorbidities, history of severe hypoglycemia, or advanced complications. 1

Lipid Panel (At Least Annually)

• Measure fasting lipid profile at least annually, or every two years if low-risk lipid values are present. 2
• This includes total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. 2
• Essential for cardiovascular risk assessment, as cardiovascular disease is a leading cause of morbidity and mortality in diabetes. 3

Urine Albumin-to-Creatinine Ratio (At Least Annually)

• Screen for microalbuminuria annually using the urine albumin-to-creatinine ratio, as this detects early, reversible diabetic nephropathy. 4
• Albumin-to-creatinine ratios of 0.03 to 0.30 (g/g) indicate microalbuminuria. 4
• Random urine samples are convenient and effective for screening. 4

Tests NOT Routinely Recommended at 3-Month Visits

Fasting Plasma Glucose

• Routine measurement of plasma glucose in a laboratory is not recommended as the primary means of monitoring therapy in individuals with diabetes. 3
• Patients should use home glucose meters or continuous glucose monitoring for day-to-day management. 5
• Laboratory glucose testing is reserved for diagnosis and screening, not routine monitoring. 3

Common Pitfalls to Avoid

• Do not use point-of-care HbA1c devices that are CLIA-waived without proper proficiency testing, as these should be restricted to FDA-approved devices at CLIA-certified laboratories performing moderate complexity testing or higher. 1
• Do not skip HbA1c testing at the 3-month visit if the patient has not achieved glycemic targets or if therapy has recently changed—quarterly testing is specifically recommended in these situations. 1, 6
• Do not rely solely on patient-reported home glucose values without objective HbA1c measurement, as adherence to HbA1c monitoring guidelines is associated with better diabetes control. 6

Testing Frequency Algorithm

If HbA1c is at target and stable:

• HbA1c every 6 months 1
• Lipid panel annually 2
• Urine albumin-to-creatinine ratio annually 4

If HbA1c is not at target or therapy has changed:

• HbA1c every 3 months (quarterly) 1
• Lipid panel annually 2
• Urine albumin-to-creatinine ratio annually 4