Diabetes Canada states that in 2018, over 3.5 million
people (about 9% of the population) in Canada
have been diagnosed with diabetes, with as many
as 10.7 million (28% of the population) currently
at-risk, or undiagnosed.1 With increase in the rates of
obesity and large sections of the population leading
a sedentary lifestyle, the need for detailed diabetes
risk assessment, prevention, and management has
become critical.
LifeLabs offers a comprehensive array of diabetes
laboratory testing services to help healthcare
providers manage diabetes in patients of all ages,
and in all stages of the diabetes care continuum.
LifeLabs Diabetes Laboratory Testing Services
2 LifeLabs DIABETES LABORATORY TESTING SERVICES
Why Choose LifeLabs?
According to Diabetes Canada 2018 Guideline definitions:
• Diabetes Mellitus is a heterogeneous metabolic disorder where
hyperglycemia (high levels of glucose in the blood) occurs due to impaired
glucose secretion, defective insulin action, or both. Chronic hyperglycemia
of diabetes can lead to microvascular complications affecting kidney, eyes
and nerves, and increase the risk of cardiovascular disease. The diagnostic
criteria for diabetes are based on thresholds of glycemia that are associated
with microvascular disease, especially retinopathy.2
• Prediabetes is a practical and convenient term referring to impaired fasting glucose (IFG), impaired glucose tolerance (IGT)
or a glycated hemoglobin (A1c) of 6.0% to 6.4%, each of which places individuals at high risk of developing diabetes and its
complications.3
Over 360
LifeLabs locations offer diabetes test collection
services
We accept walk-ins, as well as appointments for
diabetes tests
Quick turn-around
time (TAT) allows for fast decision-making in treatment
management
Electronic reporting with direct
results integration into most EMR’s
Launchpad – an online physician portal with 24/7 remote access
to results
Consultations
with our team of pathology specialists
when required
Diabetes Risk Assessment and Early Diagnosis Tests
LifeLabs diabetes tests help you make a proactive approach to preventing, diagnosing and managing diabetes.
3LifeLabs DIABETES LABORATORY TESTING SERVICES
FASTING PLASMA GLUCOSE (FPG)
Measured in mmol/L, this test measures the level
of glucose in the blood after fasting for at least
8 hours. While FPG levels below 5.6 mmol/L are
considered normal, results between 6.1 mmol/L
and 6.9 mmol/L indicate impaired fasting glucose
and therefore, prediabetes. FPG levels over 7.0
mmol/L indicate diabetes.4
HEMOGLOBIN A1c (HB A1c)
Hemoglobin A1c, also called A1c or glycated
hemoglobin, is formed by the non-enzymatic
glycation reaction between the ß chain of
hemoglobin A0 and glucose.19
The A1c test evaluates the average amount of
glucose in the blood over the last 2 to 3 months
by measuring the percentage of glycated
(glycosylated) hemoglobin. A1c % between 6 and
6.4 may be considered prediabetes, whereas 6.5
and over indicates diabetes.5
A1c is a better predictor of microvascular
complications and risk of cardiovascular disease.
However, A1c is not recommended for type 1
diagnosis in adults, or for screening individuals
with iron, Vitamin B12, cystic fibrosis, kidney or
liver disorders, or for gestational diabetes. FPG is
the recommended test in those cases.6
The 2018 Clinical Practice Guidelines
released by Diabetes Canada state that
both FPG and Hb A1c are acceptable tests
to screen, diagnose and monitor individuals
with diabetes. If patient is asymptomatic,
and if either FPG or A1c results are in the
diabetes range, then repeat testing is
recommended for confirmation of diagnosis.
LifeLabs also offers the 75g 2-Hour Oral
Glucose Tolerance Test (OGTT) and
post-meal Random Plasma Glucose as
alternative tests in the diagnosis of diabetes.
4 LifeLabs DIABETES LABORATORY TESTING SERVICES
Other Metabolic Markers to Assess Diabetes
FRUCTOSAMINE*
Also known as Glycated Serum Protein, Fructosamine is
a test used to monitor blood sugar levels over time for a
patient with diabetes mellitus. The level of fructosamine
in the blood is a reflection of glucose levels over the
previous 2-3 weeks.
GLYCOMARK*
The GlycoMark test measures 1,5-AG, a specific indicator
of hyperglycemic episodes and glycemic variability within
the past 1-2 weeks. This test is a non-fasting, FDA-cleared,
serum or plasma blood chemistry test. This test is useful
in detecting blood sugar levels over short periods of time,
which can help the healthcare provider in optimizing the
diabetes management / treatment plan.
25 HYDROXY VITAMIN D
Low levels of Vitamin D are associated with increased risk
of CVD events, myocardial infarction (MI), and death due
to heart failure, sudden cardiac death, and stroke. The
cardiovascular impact of low vitamin D is via activation of
the renin-angiotensin-aldosterone system, as well as via
increased parathyroid hormone levels (which predispose
individuals to increased insulin resistance associated
with diabetes, hypertension, inflammation, and increased
cardiovascular risk).
*Provincial health plan coverage for fructosamine varies by province or by specific clinical indications. The GlycoMark test is currently an uninsured test.
5LifeLabs DIABETES LABORATORY TESTING SERVICES
Diabetes Classification Tests
In cases where the type of Diabetes is not clear based
on clinical assessment (e.g. age of onset, body weight,
response to oral hypoglycemics etc.), some lab tests can
help to differentiate between types.
Type 1 diabetes encompasses diabetes that is primarily
a result of auto-immune pancreatic beta cell destruction
with consequent insulin deficiency, which is prone to
ketoacidosis. This also includes Latent Autoimmune
Diabetes in Adults (LADA) in patients that appear to
have immune-mediated loss of pancreatic beta cells.
Type 2 diabetes may range from predominant
insulin resistance with relative insulin deficiency to a
predominant secretory defect with insulin resistance.
Ketosis is not as common and no auto-immune processes
are involved.
When autoimmune type 1 diabetes is present, one or more of the diabetes autoantibodies will be present in
about 95% of those affected at the time of initial diagnosis. With type 2 diabetes, the autoantibodies are
typically absent.
ISLET CELL CYTOPLASMIC AUTOANTIBODIES (ICA) TEST
Beta cells are a type of islet cells. This test measures a group of islet cell autoantibodies targeted against a variety
of islet cell proteins. These autoantibodies are present in up 80% of type 1 diabetic adults. Islet autoantibodies may
also be seen in people with other autoimmune endocrine disorders such as Hashimoto thyroiditis or autoimmune
Addison disease.
6 LifeLabs DIABETES LABORATORY TESTING SERVICES
The 2018 Clinical Practice Guidelines released by Diabetes Canada recommends an initial 50g glucose
challenge test, followed, if abnormal, with a 75g oral glucose tolerance test (2h OGTT). A diagnosis of GDM is
made if one plasma glucose value is abnormal (i.e. if fasting ≥5.3 mmol/L, or 1hour ≥10.6 mmol/L, or 2 hours
≥9.0 mmol/L). The alternate approach is a 1-step approach of a 75 g oral glucose tolerance test. A diagnosis of
GDM is made if one plasma glucose value is abnormal (i.e. if fasting ≥5.1 mmol/L, or 1 hour ≥10.0 mmol/L, or 2
hours ≥8.5 mmol/L).7
Other specific types include a wide variety of relatively uncommon conditions, primarily specific genetically
defined forms of diabetes or diabetes associated with other diseases or drug use.
INSULINOMA-ASSOCIATED-2 AUTOANTIBODIES (IA-2A)
IA-2A test detects autoantibodies directed against
beta cell antigens but is non-specific. These auto-
antibodies are found in up to 60% of type 1 diabetics.
INSULIN ANTIBODIES (IAA)
The autoantibodies seen in children are often
different than those seen in adults. Insulin Antibodies
(IAA) is usually the first marker to appear in young
children. As the disease evolves, this may disappear
and ICA, GADA and IA-2A become more important.
GLUTAMIC ACID DECARBOXYLASE AUTOANTIBODIES (GADA) TEST
GADA test detects autoantibodies directed against
beta cell protein (antigen) but is not specific to beta
cells. These autoantibodies are also detected in up to
80% of newly diagnosed type 1 diabetics.
GESTATIONAL DIABETES MELLITUS
(GDM) refers to glucose intolerance with onset or first
recognition during pregnancy.
7LifeLabs DIABETES LABORATORY TESTING SERVICES
Diabetes Genetic Laboratory Tests Monogenic diabetes is a rare disorder caused by genetic
defects of beta cell function that typically presents in
young people (<25 years of age), is noninsulin dependent
and is familial, with an autosomal dominant pattern
of inheritance. The most common form of monogenic
diabetes is maturity-onset diabetes of the young
(MODY), which represents about 2% of all diabetes
cases.8
MODY PANEL
LifeLabs offer comprehensive testing for MODY as well as
genetic testing expertise and genetic counselling through
our LifeLabs Genetics division. Several different genes
that affect the production of insulin are grouped under
the LifeLabs MODY panel. These include ABCC8, BLK,
CEL, GCK, HNF1A, HNF1B, HNF4A, INS, KLF11, NEUROD1,
PAX4, NKX2-2, PDX1, RFX6, and ZFP57.
15 different conditions are tested as part of the panel.
These include:
• Diabetes Mellitus Type 2 and insulin-dependent Type 1
• Familial hypoplastic or glomerulocystic kidney disease
• MODY type 1 to 11
• Michelle-Riley Syndrome
• Transient neonatal diabetes mellitus 1
These tests can be ordered on the LifeLabs Hereditary Testing National Requisition.
Contact the team at [email protected] or call
1-84-GENEHELP (1-844-363-4357)
8 LifeLabs DIABETES LABORATORY TESTING SERVICES
Prediabetes and type 2 diabetes are often indicative of a broader underlying disorder, including the metabolic syndrome
(MetS), a highly prevalent condition that is accompanied by obesity, hypertension, dyslipidemia and elevated blood
glucose levels. While metabolic syndrome and type 2 diabetes often coexist, those with metabolic syndrome without
diabetes are at significant risk of developing diabetes as well as cardiovascular disease (CVD).13
MetS is diagnosed when a patient has three of the following conditions14:
✓ High blood pressure (≥ 130/85 mm Hg, or receiving
medication)
✓ High blood glucose levels (≥ 5.6 mmol/L, or receiving
medication)
✓ High triglycerides (≥ 1.7 mmol/L, or receiving medication)
✓ Low HDL-Cholesterol (< 1.0 mmol/L in men or < 1.3
mmol/L in women)
✓ Large waist circumference (≥ 102 cm in men, 88 cm in
women; ranges vary according to ethnicity)
Canadian clinical practice guidelines recommend Fasting
Plasma Glucose (FPG), Lipid Assessments and regular blood
pressure measurement to diagnose and manage MetS.
METABOLICSYNDROME
Visceral Obesity
Insulin
Resistance
Hypertension
High
Triglycerides
Low HDL-
Cholesterol
METABOLIC SYNDROME TESTS
Diabetes Monitoring and Cardiac Risk Assessment Tests Monitoring - For most individuals with diabetes, Hb A1c
should be measured approximately every 3 months to
ensure that glycemic goals are being met or maintained.
The 2018 Clinical Practice Guidelines released by
Diabetes Canada recommend that the frequency of Hb
A1c testing be increased if assessing response to therapy
or during pregnancy. Additionally, Serum Ketones is a
test recommended for adults with type 1 diabetes during
periods of acute illness and if accompanied by elevated
blood glucose levels.9
Cardiac Risk - Cardiovascular disease is the leading
cause of mortality in patients with Type 2 Diabetes
Myocardial infarction (MI), stroke and amputation are all
manifestations of the aggressive atherosclerosis that can
occur with diabetes10
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LIPID ASSESSMENT
This is a panel of blood tests that serves as an initial
broad medical assessment tool for abnormalities
in total cholesterol, HDL cholesterol (calculated),
triglycerides, LDL cholesterol (calculated), non-HDL
cholesterol and cholesterol/HDL-C ratio. A lipid panel
can used to identify hyperlipidemia, which may indicate
an increased risk for CVD.
A lipid panel may also be ordered at regular intervals
to evaluate the success of lipid-lowering lifestyle
changes such as diet and exercise or to determine the
effectiveness of drug therapy such as statins.
Studies have shown that identifying individuals
in the very early stages of kidney disease helps
people and healthcare providers adjust treatment.
Controlling diabetes and hypertension by
maintaining tight glycemic control and reducing
blood pressure delay or prevent the progression
of kidney disease.
APOLIPOPROTEIN B
Apo B is the predominant apolipoprotein attached to
LDL, intermediate-density lipoproteins (IDL), and very
low-density lipoproteins (VLDL). Guidelines support
the measurement of apo B for monitoring response to
statin therapy or those with very high triglycerides. An
elevated Apo B level is associated with an increased risk
of CVD by up to 2.5 times.12
ALBUMIN CREATININE RATIO – RANDOM URINE
Hypertension Canada guidelines recommend testing
urinary albumin excretion in patients with diabetes to
guide treatment of hypertension11. The urine albumin/
creatinine ratio (ACR) is used to screen people with
chronic conditions (such as diabetes with hypertension)
that put them at an increased risk of developing kidney
disease. Please refer to the section on monitoring
kidney function to learn more.
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ALANINE AMINOTRANSFERASE (ALT)
ALT is an enzyme found mostly in the cells of the liver and kidney. When the
liver is damaged, ALT is released into the blood. ALT values are often compared
to the results of other tests such as alkaline phosphatase (ALP), total protein,
and bilirubin to help determine which form of liver disease is present.
Monitoring Liver Function in Diabetes
ASPARTATE AMINOTRANSFERASE (AST)
The test is most useful in detecting liver damage due to hepatitis,
drugs toxic to the liver, cirrhosis, or alcoholism. An AST test is often
performed along with an ALT test. A calculated AST/ALT ratio is useful
for differentiating between different causes of liver injury and in
recognizing when the increased levels may be coming from another
source, such as heart or muscle injury.
ALBUMIN
Albumin is a protein found in the blood. Since albumin is
produced by the liver, its level can decrease with loss of liver
function; however, this typically occurs only when the liver
has been severely affected. An albumin test may be ordered
as part of a liver panel to evaluate liver function or with
a creatinine, blood urea nitrogen (BUN), or renal panel to
evaluate kidney function.
LifeLabs offers tests to identify individuals with non-alcoholic fatty liver disease (NAFLD) who are
at a high risk of serious liver complications. While overall prevalence of NAFLD is estimated to be
anywhere from 6.3% to 33%, the rate is more than double that in people with type 2 diabetes.15 In its
most indolent form, NAFLD is characterized by the histologic accumulation of fat within hepatocytes.
In some patients, this fat accumulation is accompanied by varying degrees of inflammation and
fibrosis - which may progress to cirrhosis and associated complications.
In recent studies, NAFLD has been shown to predict the development of type 2
diabetes and vice versa.16 Each condition may serve as a progression factor for
the other, and some complications of diabetes may be directly linked to NAFLD.17
11LifeLabs DIABETES LABORATORY TESTING SERVICES
Monitoring Kidney Function in Diabetes
CHRONIC KIDNEY DISEASE (CKD) TESTS
Chronic kidney disease (CKD)is an important common
complication of diabetes. CKD due to diabetes occurs
in 20% to 40% of patients and is the most common
cause of end-stage renal disease.18 Both type 1 and type 2
diabetes patients are at risk. LifeLabs offers specific tests
to monitor chronic kidney disease (CKD) in patients with
diabetic nephropathy.
SERUM CREATININE eGFR
Glomerular filtration rate (GFR) is a measure of the
function of the kidneys. This test measures the level of
creatinine in the blood and uses the result in a formula to
calculate a number that reflects how well the kidneys are
functioning, called the estimated GFR or eGFR. The eGFR
is a calculation based on a serum creatinine test.
ALBUMIN CREATININE RATIO – RANDOM URINE
The urine albumin/creatinine ratio (ACR) is used to
screen people with chronic conditions (such as diabetes
with hypertension) that put them at an increased risk of
developing kidney disease.
ELECTROLYTES
The electrolyte panel measures the blood levels of the
main electrolytes in the body: sodium (Na+), potassium
(K+), chloride (Cl-), and bicarbonate (HCO3-; sometimes
reported as total CO2). Electrolyte measurements may be
used to help investigate conditions that cause electrolyte
imbalances such as dehydration, kidney disease, lung
diseases, or heart conditions. Repeat testing may then
also be used to monitor treatment of the condition
causing the imbalance.
URINE PROTEIN TO CREATININE RATIO (UP/CR)
This test detects not just albumin, but all types of
proteins that may be present in the urine.
PARATHYROID HORMONE (PTH)
PTH controls calcium levels in the blood, and is often
increased in kidney disease.
LifeLabs3680 Gilmore WayBurnaby, BCV5G 4V8
CORPORATE OFFICES
LifeLabs100 International BlvdToronto, ONM9W 6J6
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1. “Diabetes statistics in Canada are estimates generated by the Canadian Diabetes Cost Model, a forecasting model that provides projections on prevalence, incidence and economic burden of diabetes in Canada based on national data from government sources.” – Diabetes Canada media sources, updated: March 2018
2 – 7,9,10,13. 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada; Can J Diabetes 2018;42 (Suppl 1):S88-S103.
8. Naylor R, Philipson LH. Who should have genetic testing for maturity-onset diabetes of the young? Clin Endocrinol. 2011;75:422-426
11. Kara A. et al. Hypertension Canada’s 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children. Can J Cardiol.
12. Anderson TJ, Grégoire J, Hegele RA, et al. 2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2013;29:151-167.
14. Metabolic Syndrome Canada, web sources ‘What is Metabolic Syndrome’
15. Chalasani N, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidelines by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005-2023.
16, 17. Williams KH, et al. Diabetes and nonalcoholic fatty liver disease: a pathogenic duo. Endocr Rev. 2013;34:84-129.
18. American Diabetes Association. Standards of medical care in diabetes—2017. Diabetes Care. 2017;40(suppl 1):S1-S120.
19. Farmer, Andrew. Monitoring Diabetes. In: Holt, Richard I.G et al (eds) Textbook of Diabetes. 5th ed. Wiley Blackwell, 2017 (p 375).