AACC Releases Comprehensive Diabetes Testing Guidelines

Diabetes, a condition impacting an estimated 537 million people worldwide, is a disorder where the body either underproduces or underutilizes insulin, causing glucose (or sugar) from food to accumulate in the blood. The condition predisposes people to an elevated risk of heart attacks, stroke, vision loss, kidney disease, and other health issues. Now, the American Association for Clinical Chemistry (AACC, Washington, DC, USA), in collaboration with the American Diabetes Association (Arlington, VA, USA), has released evidence-based guidelines to assist in diagnosing and managing patients with diabetes using the most advanced laboratory analysis tools. These updated guidelines stem from an exhaustive evaluation of cutting-edge diabetes laboratory tests' quality and efficacy.

The recently introduced guidelines replace those published in 2002 and 2011 and offer comprehensive updates on continuous glucose monitoring and more accurate guidance for glucose and hemoglobin A1c measurements, which serve as an average blood glucose marker. A multidisciplinary team of medical experts has authored the new guidelines, providing specific, actionable suggestions designed to encourage collaboration among healthcare professionals and improve care for millions of individuals.

One of the key inclusions in the 2023 document is its in-depth guidance regarding continuous glucose monitoring (CGM). With this technology, a device gauges a patient's blood glucose every 5-15 minutes, and an automatic pump dispenses insulin when necessary. The expert panel strongly advocates the use of real-time CGM, coupled with insulin, in certain teenagers and adults with type 1 diabetes—a form of disease where the body fails to produce insulin. The guidance applies to type 1 diabetes patients struggling to meet their blood sugar (glycemic) targets, those unaware of their low blood sugar, and/or those prone to hypoglycemia. While CGM isn't often employed for type 2 diabetes—where the body doesn't utilize insulin effectively—the guidelines recommend healthcare providers consider CGM for insulin-dependent type 2 patients who are not meeting glycemic targets.

The new guidelines also suggest that healthcare professionals use blood collection tubes containing a citrate buffer to prevent glucose breakdown after blood sample collection, as this could compromise measurement accuracy. When these tubes aren't available, an alternative technique involving an ice-water bath and other steps is recommended. According to the guidelines, fasting glucose values above 7.0 mmol/L (>126 mg/dL), and hemoglobin A1c measures of at least 6.5% (>48 mmol/mol), should be deemed indicative of diabetes.

Furthermore, the guidelines offer new guidance for standardizing measurements of insulin and C-peptide—a marker that differentiates between type 1 and type 2 diabetes. The latest updates also cover autoimmune and genetic markers for type 1 diabetes, including a promising gene mutation analysis that can identify rare neonatal diabetes forms. The newly-released guidelines aim to equip the entire healthcare team with the necessary tools to make the most effective clinical decisions by fostering a deeper understanding of lab tests' strengths and limitations.

"It's important to measure accurately—but it's also very important to communicate the relevance to clinicians and to listen to them and share information," said Dr. David Sacks, the guidelines' primary author. "Patient care is a team effort."

Related Links:
AACC 
American Diabetes Association 

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