Frequency Monitoring of Hemoglobin A1c, Low-Density Lipoprotein, and Urine Protein Laboratory Testing: A College of American Pathologists Q-Probes Study

Abstract

Context.—Ensuring laboratory tests are performed at intervals consistent with established, evidence-based guidelines in diabetic patients is an important aspect of laboratory utilization. Objectives.—To measure how frequently diabetes mellitus patients are tested for hemoglobin A1c (HbA1c), low-density lipoprotein, and urine protein and to determine whether the frequencies with which these analytes are tested are consistent with recognized guidelines. Design.—Participants prospectively identified up to 40 patients with a current HbA1c result and at least 2 previous measurements within the past 24 months. For each patient identified with at least 3 HbA1c measurements during a 24-month period, participants also determined the number of low-density lipoprotein and spot or random urine protein tests that were performed during those 24 months. Results.—Participants from 49 institutions submitted a total of 1915 cases that met the study criteria of at least 3 HbA1c test results within the past 24 months. Approximately 95% of patients had 8 or fewer HbA1c tests in the past 24 months; 79% of patients with at least 3 HbA1c tests had at least 2 low-density lipoprotein tests and 27% had at least 2 urine protein tests reported during the 24-month study period. Conclusion.—Participating laboratories were generally successful in documenting appropriate utilization of HbA1c testing in diabetes mellitus monitoring, but had more difficulty documenting that diabetes mellitus patients had annual testing for low-density lipoprotein and urine protein.