Put It on the Board

Create PDF

New guidelines published on lab analysis in diabetes

August 2023—The Association for Diagnostics and Laboratory Medicine (formerly AACC) and the American Diabetes Association last month issued guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (Sacks DB, et al. Clin Chem. 2023;69​[8]:808–868).

The two groups first issued such guidelines and recommendations in 2002 and then again in 2011. In the new publication they review and update those recommendations using an evidence-based approach, “especially in those areas where new evidence has emerged since the 2011 publications,” the authors write in an executive summary.

The guideline focuses on the practical aspects of care to assist in decisions on the use or interpretation of laboratory tests in screening for, or in diagnosing or monitoring patients with, diabetes. The recommendations primarily target laboratory professionals, general practitioners, physicians, nurses, and others involved in diabetes care.

The new document recommends that health care workers use blood collection tubes that contain citrate buffer to minimize the breakdown of glucose after blood samples are taken. “We’re trying to encourage manufacturers of blood collection tubes to make these available in the U.S.,” coauthor David Sacks, MBChB, of the NIH Clinical Center and a member of the CAP Clinical Chemistry Committee, said in a news release. If the tubes are not an option, the sample tube should be placed immediately in an ice-water slurry and subjected to centrifugation to remove the cells within 15 to 30 minutes, the recommendation says.

Among the HbA1c-related recommendations is the following good practice point: Assays of other glycated proteins, such as fructosamine or glycated albumin, may be used in clinical settings where abnormalities in RBC turnover, hemoglobin variants, or other interfering factors compromise interpretation of HbA1c test results, although they reflect a shorter period of average glycemia than HbA1c.

The guideline and recommendations are available at https://bit.ly/hvad080; the executive summary is at https://bit.ly/hvad079.