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HbA1c- Reagents, Climate Change
and Seasonality
Greetings!
This winter, we noted a higher percentage of HbA1c positives compared to historical averages. We found 3 causes for this and were reminded of an underlying truth about testing. Unlike most tests the current average applicant value for HbA1c (high 5% range) is very close to the level that is associated with extra risk (6.0% or higher). Even very small shifts in applicant results (0.2%) result in as much as a doubling of applicants recording "abnormal" results. Separating real trends from expected intra-applicant, inter-applicant and laboratory variation which, in combination, is at least this large, takes lots of data over months.
Roughly half the recent shift resulted from switching to a new reagent lot which, although it tested within tolerance at QA, had an impact on the number of applicants in the HbA1c 6.0 to 6.4% range.
But the other half of the increase results from increasing applicant obesity and age (climate change) and a degree of seasonality we had not fully recognized. All measures of blood sugar including the blood sugar values and fructosamine values are gradually going up. Obviously, clinicians and public health advocates are aware of the trend as well.
The degree of seasonality on top of climate change was the surprise. Other authors have reported this and all our measures of blood sugar confirm it. Since HbA1c measures average blood sugar over 2 to 3 months and blood sugar is controlled by calories balanced by physical activity, winter is associated with a higher HbA1c. This occurs in Hawaii and California as well as the Midwest because activity and eating patterns vary by season for warmer and for colder places. And because of the "truth" noted above, big shifts in the number of elevated values occur with small shifts in HbA1c levels.
For insurers doing universal testing, expect increasing percentages of elevated HbA1c values overall and a higher percentage in winter. For those reflexing off fructosamine, the trends are attenuated since fructosamine is less sensitive to mild blood sugar elevations associated with HbA1c values in the 6.0 to 6.4% range.
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CDT and Serum Alcohol: What is the Risk?
On the Risk vol.24 n.1 (2011)
Mortality in insurance applicants who are serum alcohol or CDT positive is at least twice as high as that found in applicants who are negative, after accounting for age, sex and tobacco use differences.
(Click on link above to read full article)
Albumin and All-Cause Mortality Risk in Insurance Applicants
J. Insurance Medicine 2010; 42:11-17
By use of the Social Security Death Master File, mortality was determined in 1,704,566 insurance applicants for whom blood samples were submitted to CRL. The results concluded that when stratified by age and sex, albumin discriminated between all-cause mortality risks in healthy adults at all ages and across a wide range of values independent of other laboratory tests.
(Click on link above to read full article) |
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SEHOUA Conference 2011
June 22-24
Myrtle Beach, South Carolina
Chicago, Illinois
October 2-5
Chicago, Illinois
November 17-19
Phoenix, Arizona |
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A SPECIAL THANKS!
Thanks to all of you who were able to stop by our booth at AHOU. It was a terrific meeting for us and we appreciated the opportunity to talk about your business and how we might better serve all of you.
And THANKS for spending the evening with us at Margaritaville on Monday evening. What a great time! Lots of fun, food, good music and great friends. It doesn't get much better than that. Looking forward to being with all of you in Orlando next year. |
| Copyright 2010 Clinical Reference Laboratory, Inc.
CRL is a registered trademark of Clinical Reference Laboratory, Inc.
Clinical Reference Laboratory
8433 Quivira Road | Lenexa, Kansas | 1-800-445-6917
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SWIFT SCREENTM
Professional. Custom. Efficient.When a case requires ECG review, your turnaround time doesn't have to be affected. Clinical Reference Laboratory, Inc.TM, (CRL®) offers Swift ScreenTM, an ECG review service you can order along with your applicant's laboratory testing. Our team of respected medical directors from the insurance industry are available to review ECGs using your specific guidelines. Turnaround time is less than 24 hours. Benefits Your own medical/underwriting staff are free to focus on other cases All ECG reviews are custom, performed according to your guidelines Quick access to top medical directors' opinions any time you need it To learn more about Swift ScreenTM, please contact your CRL Sales Representative or call 1-800-882-1922.
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What is Sample Watch?
CRL's Sample Watch provides a means to request the additional testing BEFORE the sample is received at the laboratory. You have an applicant that due to medical history, or other information available, requires testing outside the defined testing requirements. How does the underwriter request that additional testing with the minimum delay to the underwriting cycle?
The underwriter enters applicant information and the additional testing required in Sample Watch in WebOasis, or alternatively they can contact Customer Service to enter the information. Information entered in Sample Watch is active for 90 days, providing sufficient time for the sample to be collected and received at the laboratory. When the sample arrives and applicant information on the consent matches applicant information on the sample, the additional testing is requested before the sample is reported. This allows the testing to be completed and reported with the original testing, allowing the underwriter to receive a complete report the first time.
For further information regarding Sample Watch, please Contact Customer Service at 1-800-882-1922.
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Aplifi and CRL Align to Deliver Electronic Lab Results via PolicyBox!
Click here to read our press release!
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