David Sacks

Guidelines for laboratory analysis in diabetes mellitus

Guidelines for laboratory analysis in diabetes mellitus The dramatic rise in the prevalence of obesity has been accompanied by a concomitant increase in the number of individuals with diabetes mellitus. The global projection is that by 2045 there will be 783 million adults with diabetes. The multiple cardiovascular, renal and retinal complications lead to considerable morbidity and high mortality. Effective treatment can reduce the risk of complications. Large-scale, prospective clinical trials, most notably the Diabetes Control and Complications Trial (DCCT; type 1 diabetes) and the United Kingdom Prospective Diabetes Study (UKPDS; type 2 diabetes), documented that improved glycemic control significantly reduced by 35% to 90% the rate of development and progression of the microvascular complications of diabetes. The clinical laboratory has an integral role in both the diagnosis and monitoring of diabetes. Multiple tests are used in the evaluation of these patients and new tests continue to emerge. Evidence-based recommendations have been developed for the use of laboratory analysis in patients with diabetes. Recommended guidelines encompass all analytes used in diabetes, ranging from measurement of glucose and HbA1c to autoimmune and genetic markers. Outcome studies provide data to permit the development of guidelines to promote the practice of evidence-based medicine in the diagnosis and management of patients with diabetes.