Diabetes Hub

General Details of Annual Retinal Exam

An annual retinal exam is used to monitor the tiny blood vessels in the retina. With consistent checks, the annual retinal exam has a high success rate of early detection leading to early treatment to prevent vision loss. The exam is especially important for patients with diabetes who are more at-risk for damage to the retinal blood vessels in addition to glaucoma and other eye issues. Most diabetic patients do not have symptoms of vision loss, so this is why annual retinal exams are so important for successful early detection and treatment. Your healthcare professional who you see for your diabetes care may perform an eye exam, but it’s vital that your annual retinal exam be performed by an eye doctor with specific training for diabetic patients. They are knowledgeable about the eye problems that are common for those with diabetes. Eye drops that dilate the pupils of your eyes will be used to perform the exam when the eye doctor will also use a bright light and magnifying glass to examine each of your eyes thoroughly. The blood vessels of the eye, optic nerve, and back of eye are all checked during the exam.

Disparities of Annual Retinal Exam

The vision issues of diabetic retinopathy and diabetic macular edema impact BIPOC patient groups of Black, Latinx, and Native American patients at higher rates than their white counterparts. Black and Latinx patients are two to three times more likely to experience these diabetic vision issues than white patients, and these patients also receive this vital preventative retinal exam screening at a lower rate. Additional socioeconomic factors have also been noted as contributors to disparities in annual retinal exam rates and diabetic vision issues.

Why This Matters

It’s important to note that early detection leading to early treatment of diabetic-related retinal disease has shown success at reducing severe vision loss by 94 percent. A recent study also noted that a “diabetes belt” exists in what is primarily the southern U.S. where socioeconomic factors such as geographic location, insurance payor, education level, health literacy, and income level impact the disparity rates of diabetic-related retinal disease and annual retinal exam screening.

Call to Action

It’s vital for patients with diabetes to receive a retinal exam each year. You can make a note on your calendar to make sure to ask your healthcare professional each year. And if you run into issues with scheduling, be sure to advocate for yourself that an annual retinal exam is recommended for all diabetes patients.

Brooke Whitaker, DCLS, MLS(ASCP)cm is a doctor of clinical laboratory science. You can find her on Twitter: @BrookeW74021416

General Details of Digital Diagnostic Approaches

Digital diagnostics in healthcare is a blossoming area that covers a wide variety of diagnostic tests and analysis that continues to expand in new ways. In fact, digital diagnostics can include blood tests, biopsies, imaging, genetic testing, and remote monitoring of vital signs and organ function. Artificial intelligence (AI) is increasingly being used to process and analyze digital diagnostic testing, which generates multiple benefits of reducing the percentage of errors in test results, decreasing some tedious test interpretation tasks, and increasing face-to-face time for patients with their healthcare professionals. In addition, expanding the use of digital diagnostics can help create more equitable care for marginalized patients both in the U.S. and around the world.

Disparities of Digital Diagnostic Approaches

Some medical research studies have analyzed the link between diagnostic errors and health care disparities. One example of these studies includes increased likelihood of misdiagnosis using genetic testing with patient diagnostic tools that were created with less diverse patient populations. Another example includes a research study that concluded that Black patients were more likely to be underdiagnosed with depression compared to their white counterparts in cases when they visited their primary care clinics for mental health concerns.

Why This Matters

Diagnostic errors that lead to underdiagnosis and misdiagnosis of patient conditions may lead to reduced quality of life and even higher death rates for some conditions. Standardized digital diagnostic approaches can be a powerful tool in moving toward equitable medical diagnostic testing and care for all. As diagnostic data for all patient populations becomes more readily available, analysis and, in turn, patient diagnosis and care will become more refined for improved care no matter patient gender, geographic location, socioeconomic status, or racial or ethnic background. A wide range of medical conditions can benefit from more timely and accurate diagnosis including conditions such as lung cancer, breast cancer, genetic abnormalities discovered during prenatal care, and heart defects and conditions.

Call to Action

Digital diagnostic approaches are essential for moving toward equitable care for all patients. Any patient advocates who want to advocate for improved care can write to their congresspeople to support standardized diagnostic testing for all. During your next visit to your healthcare professional, ask them how digital diagnostics are assisting them in patient care.

Brooke Whitaker, DCLS, MLS(ASCP)cm is a doctor of clinical laboratory science. You can find her on Twitter: @BrookeW74021416.

General Details of Hemoglobin A1c Test

The hemoglobin A1c (HBA1c) measures the percentage of glucose attached to hemoglobin A and gives an estimate of how much glucose has been in a person’s bloodstream over the last three months. The hemoglobin A1c test may be ordered for a variety of patient situations including screening for, diagnosis of, or monitoring diabetes; screening for or diagnosis of prediabetes; or screening those over the age of 40 who are overweight, obese, or at high risk of diabetes. The HBA1c test may sometimes be ordered twice a year for monitoring patients with diabetes. The U.S. Centers for Disease Control and Prevention recommend that all adults who are age 45 or older receive a hemoglobin A1c test to get a baseline result for health maintenance. It’s important to screen for prediabetes and diabetes, because dangerously high blood sugar levels as a result of uncontrolled diabetes can lead to organ damage. Symptoms of diabetes may include blurred vision, frequent urination, excessive thirst, feeling extremely tired, and tingling or loss of sensation in the hands and feet.

Disparities of Hemoglobin A1c (HbA1c) Test

A study on HbA1C test levels in non-Hispanic Black versus white patients showed that Black patients have higher levels of HbA1c. The study researchers concluded that there is a need to individualize hemoglobin A1c levels for diagnosis of prediabetes and diabetes for Black patients. Another research study examined hemoglobin A1c testing in youth-onset type 1 and type 2 diabetes during the transition to adulthood. This study found that there were disparities in the number of HbA1c tests per year for youth-onset diabetes patients who were diagnosed before age 20, which results in fewer hemoglobin A1c tests for these younger patients leading to more complications for the youth-onset type 1 diabetes patients. The researchers determined that healthcare-related factors of lapses in health insurance, not having a personal healthcare provider, and longer duration of diabetes were factors in not receiving three of more HbA1c tests per year. [ You may want to consider - I think it is important to note that fasting glucose levels are still used to screen and diagnose type-1 and type-2 diabetes. HbA1C is not the only test available for screening and diagnosis. There are also disparities in individuals with an abnormal hemoglobin (hemoglobinopathies), HbA1c is not an accurate reflection of blood glucose levels over the last three months. Another test, fructosamine, is preferred for monitoring in individuals with a hemoglobinopathy.]

Why This Matters

Monitoring of disparities in hemoglobin A1c test metrics and frequency of testing is vital to provide optimal detection, diagnosis, and treatment for prediabetes and diabetes. It’s important to note that prescribing diabetes medications in unnecessary cases can sometimes lead to dangerous levels of low blood glucose levels. In severe cases of low glucose levels, the condition can lead to seizures, coma, or in some rare cases even death. And for diabetic patients who are not meeting glycemic goals, the American Diabetes Association recommends that these patients receive HbA1c testing four times per year.

Call to Action

If you are a patient with diabetes; prediabetes; or if you are over the age of 40 and overweight, obese, or at high risk for diabetes; ask your healthcare professional when you should receive hemoglobin A1C testing. A minimum of twice a year HbA1c testing is recommended by the American Diabetes Association for diabetes patients meeting glycemic goals and four times a year for patients not meeting glycemic goals. Optimal patient health depends on hemoglobin A1c testing and symptom monitoring. Ask your healthcare professional if you have additional questions about screening, diagnosis, or monitoring of prediabetes or diabetes.

Brooke Whitaker, DCLS, MLS(ASCP)cm is a doctor of clinical laboratory science. You can find her on Twitter: @BrookeW74021416

General Details of LDL Cholesterol Testing

LDL cholesterol (LDL-C) testing involves checking levels of low-density lipoprotein in the blood. LDL cholesterol is also known as the “bad cholesterol” due to the likelihood that high levels will clog the arteries, which is in contrast to high-density lipoprotein (HDL), also known as “good cholesterol.” The buildup of plaque in the arteries may lead to health complications. Your healthcare professional may order this test on an annual basis as part of preventative care against risk of diabetes, stroke, heart disease, and other health conditions – or they may order it as part of regular monitoring while under treatment with cholesterol-lowering medications. LDL cholesterol testing can be carried out in one of two ways – direct LDL cholesterol testing or calculated LDL cholesterol testing. As the name implies, direct LDL cholesterol testing measures only your levels of LDL cholesterol in your blood and may be used for testing if you also have high triglycerides. While calculated LDL cholesterol testing calculates levels by measuring triglycerides, HDL cholesterol, and total cholesterol and then estimates LDL levels. Frequency of testing will depend on patient age and risk factors. Testing can be performed either in a doctor’s office, medical laboratory, or even a patient’s own home. Some tests require that the patient fast and only drink water for 8 to 12 hours before blood is drawn for the test, while other tests do not require fasting. Make sure to ask your doctor if you have any questions about food and drink restrictions before your test.

Disparities of LDL Cholesterol Testing

Risk factors that warrant more frequent LDL cholesterol testing for some patients include a diet high in saturated fat, smoking, sedentary lifestyle, obesity, type 2 diabetes, high blood pressure, or a family history of heart disease. A U.S. study of that examined testing trends for total cholesterol, lipids, and LDL-C levels and showed a disparity for Hispanic patients. The Hispanic patient group had a lower percentage of testing compared to their counterparts of non-Hispanic Asians, non-Hispanic Blacks, and non-Hispanic whites.

Why This Matters

Regular screening of LDL-C levels is a necessity for the prevention of health conditions like buildup of plaque that can lead to heart attack and stroke. It’s vital that all patient groups receive regular preventative screening, and those with risk factors of a diet high in saturated fat, smoking, sedentary lifestyle, obesity, type 2 diabetes, high blood pressure, or a family history of heart disease should receive screening and monitoring.

Call to Action

Patients 65 years of age or older should receive LDL-C testing annually. Men ages 45 to 65 years and women ages 55 to 65 without risk factors should receive the test every one to two years. Younger patient groups without risk factors need less fr@BrookeW74021416equent LDL cholesterol testing. Try to keep a record or check your patient portal to ensure that you stay on track with screening. If you have questions, ask your healthcare professional and make sure to emphasize if you have a risk factor or factors that warrant more frequent monitoring.

Brooke Whitaker, DCLS, MLS(ASCP)cm is a doctor of clinical laboratory science. You can find her on Twitter: @BrookeW74021416