The Laboratory Impact on Chronic Disease Testing

Chronic diseases and conditions are the leading cause of death and disability in Ontario. The most common are cancers, cardiovascular diseases, chronic respiratory diseases and diabetes. (Public Health Ontario, 2019)

Chronic conditions are responsible for up to two thirds of death in Ontario, and 242,054 hospitalizations. Ontarian’s are at a high risk for chronic condition development since only 13% of adults do not perform the modifiable high-risk activities for chronic disease: tobacco smoking, alcohol consumption, physical inactivity and unhealthy eating (Public Health Ontario & Cancer Care Ontario, 2019).

One of the chronic conditions that impacts Ontario is Diabetes. In 2015, 81,700 people in Ontario were newly diagnosed with diabetes and 1.3 million were living with a diagnosis of the disease. Diabetes caused 14,509 hospitalizations in 2016 alone (Public Health Ontario & Cancer Care Ontario, 2019).

Diabetes requires laboratory monitoring for glucose and hemoglobin A1C levels, glucose meters for testing at the patient bedside, or self monitoring of blood glucose levels at home. Glucose meters within hospitals are overseen by a point of care program in the laboratory. Like all laboratory tests, correct usage of screening or diagnostic tests is essential in the correct management of diabetes. Diabetes Canada recommends self monitoring frequency for glucose levels based on various factors such as type of diabetes and lifestyle factors (2018).

Although glucose and hemoglobin A1C are common lab tests, additional tests may be ordered by physicians, which causes healthcare costs to increase. The National Academy of Clinical Biochemistry and the Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry jointly reviewed the guidelines for diabetes testing as a consensus conference. It was determined that certain lab tests are more beneficial to diabetes diagnosis and monitoring, such as fasting glucose, oral glucose tolerance test, and hemoglobin A1C. Random glucose testing in an accredited lab setting, urinary glucose, blood ketone, fructosamine or glycolated serum albumin are not as beneficial in the lab monitoring or diagnosis of diabetes.

A second laboratory challenge for glucose testing is that home testing for diabetes. Home testing is performed using glucose meters is that there can be notable variation in glucose testing levels depending on the manufacturer, testing strip lot number, and quality of finger prick technique, leading to an up to 20% variation in repeated results on the home monitors (Greenberg, 2012) (Ginsburg, 2010). An accurate blood glucose reading matters when selecting an insulin dose.

References

Diabetes Canada (2018). Self-Monitoring of Blood Glucose (SMBG) Recommendation Tool. https://guidelines.diabetes.ca/self-management/smbg-recommendation-sheet

Ginsberg, B. (2010). We Need Tighter Regulatory Standards for Blood Glucose Monitoring, But They Should Be for Accuracy Disclosure. The Journal of Diabetes Science and Technology. 2010 Sep; 4(5): 1265–1268 doi: 10.1177/193229681000400528

Greenberg, R. (2012, August 8) Meter Accuracy Counts More — and Less — Than You Think. The Huffington Post. https://www.huffpost.com/entry/diabetes_b_1836001

Public Health Ontario. (2019, December 17). Chronic Diseases and Conditions. https://www.publichealthontario.ca/en/diseases-and-conditions/chronic-diseases-and-conditions

Public Health Ontario & Cancer Care Ontario. (2019, July 19). The Burden of Chronic Diseases in Ontario. https://www.publichealthontario.ca/-/media/documents/c/2019/cdburden-report.pdf?la=en

Sacks, D., Arnold, M., Bakris, G., Bruns, D., Horvath, A., Kirkman, M. Lenmark, A., Metzger, B., Nathan, D. (2011). Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care 34(6): e61-e99. https://doi.org/10.2337/dc11-9998

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