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DIABETES
Standardizing and Improving Laboratory Tests for Diabetes
Each year in the United States, diabetes is diagnosed in about 800,000 people. Diabetes mellitus is a chronic metabolic disorder affecting the body's ability to make or use insulin. Insulin is the hormone that transports glucose from digested nutrients into the body's cells for energy and growth.
Diabetes causes a variety of disabling and life-threatening complications and is the leading cause of nontraumatic amputations, blindness among working-age adults, and end-stage kidney disease. National Center for Environmental Health's (NCEH) Division of Laboratory Sciences (DLS) has established a special program to standardize and improve the laboratory tests used to predict, diagnose, and monitor diabetes and its complications. This program pools expertise from several areas, including clinical chemistry, molecular biology, and newborn screening. Specific targets for improvement include tests for biomarkers (genes and proteins) that can help predict type 1 (insulin-dependent) diabetes in children before it occurs, tests used to monitor glucose control in people with diabetes who are undergoing treatment, and tests to help anticipate which people with diabetes are most likely to suffer kidney damage.
Current Research at DLS
Understanding Type 1 Diabetes
With funding from DLS, the Pacific Northwest Research Institute has established the first partnership with a state public health laboratory to better understand type 1 diabetes in children. In type 1 diabetes, the body does not produce insulin and it is referred to as insulin dependent diabetes mellitus (IDDM). People with type 1 diabetes must use insulin injections to control their blood sugar. Using dried blood spot samples taken from 30,000 children for newborn screening by the Washington State Public Health Laboratory, researchers used a new technology called the reverse microarray to analyze for the major genetic variants that influence risk for type 1 diabetes.
The reverse microarray technology allows such testing to be done with much higher throughput and lower cost than any alternative testing methods. About 5,000 children whose genetic composition puts them at higher risk for type 1 diabetes will be recruited into this surveillance study. Following these children will lead to a better understanding of the origin of the disease and allow the children to access clinical trials that will assess the value of early intervention and treatment options.
Genetic Testing
DLS is researching genes involved in susceptibility and protection to type 1 diabetes through state-of-the-art molecular techniques. The genes involved in renal disease of type 1 diabetics are also being studied in detail.
More information on this topic can be found in the Genetics section.
Autoantibody Standardization
Samples are monitored for three crucial antibodies that the body will produce when eliciting an immune response to non-foreign cells. Early detection of these antibodies is valuable, as the patient will most likely develop type 1 diabetes if all three are detected.
More information on this topic can be found in the Genetics section.
Harmonizing Glucometer Measurements
Measurement of the blood glucose concentration by patients with diabetes is an integral part in diabetes management. These measurements are performed by the patients themselves using hand-held blood glucose monitors. DLS performed studies to assess the variability of these meters and developed methods and procedures that allow the assessment of their accuracy. This will help to reduce the variability among meters and improve patient care. DLS has also supported efforts to explore new means and technologies to measure a patient's glycemic status such as the use of microneedles to measure glucose in interstitial fluids from the skin.
Standardizing Diabetes Measurement
The goal in diabetes management is to control a person's blood glucose values so that they are to be within the range seen in people without diabetes. The hemoglobin A1c (HbA1c) test measures the amount of glucose in a person's blood over a 2 - to 3 - month period and is a good indicator of diabetes control. Higher levels of HbA1c may mean that a person's diabetes is out of control. The American Diabetes Association (ADA) has set specific diabetes treatment goals for HbA1c. For this reason, the test must be accurate-otherwise, health care providers won't have the right information to make good decisions about treating patients with diabetes. DLS helps to improve the measurement of HbA1c nationally by supporting the efforts of the National Glycohemoglobin Standardization Program (NGSP) and internationally by contributing to standardization efforts by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) as an IFCC A1c reference laboratory.
Statistics
For More Information...
CDC Resources
U.S. Federal Government Resources
Non-Federal Resources
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