Laboratory Use in Individuals with Early-Onset versus Usual-Onset of Diabetes: A Retrospective Cohort Study

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Background: The incidence and prevalence of diabetes is increasing in younger individuals and these individuals are at an increased risk of complications. Laboratory testing is used to screen and monitor for complications in people with diabetes, and there is concern that this is not being achieved as per clinical guidelines. The objective of this thesis was to describe the frequency and results of guideline recommended laboratory tests in individuals with early-onset (<40 years of age) and usual-onset diabetes (≥40 years of age), and to explore clinical and sociodemographic factors related to guideline concordance of frequency of testing and results. Methods: This observational, retrospective cohort study used population-based administrative and clinical databases in Alberta from 2018 to 2019. We included adults with incident diabetes (age ≥18 years) and stratified by age of onset (<40 years versus ≥40 years). Individuals were followed for a total of 365 days for glycated hemoglobin (A1C), low-density lipoprotein cholesterol (LDL-C), estimated glomerular filtration rate (eGFR), and albumin to creatinine ratio (ACR) tests. Descriptive statistics were used to compare laboratory testing between early-onset and usual-onset groups. Multivariable logistic regression was used to assess factors related to guideline concordant testing frequency and above-target results. Results: Overall, the cohort included 23,643 individuals with incident diabetes (mean age 54.1 ± SD 15.4 years, 42.1% female). The early-onset group represented 18.9% of the cohort. A higher proportion of the early-onset group had lower frequency of testing for A1C, LDL-C, eGFR, and ACR tests and above-target test results for A1C and LDL-C compared to the usual-onset group. After adjustment of covariates (sex, socioeconomic status, rural residence, medication use), the early-onset group was more likely to have lower frequency of testing for A1C, LDL-C, and eGFR tests and above-target A1C and LDL-C levels compared to the usual-onset group. Sociodemographic and clinical factors were also associated with testing frequency and above-target test results. Conclusions: Despite a universal health care system, the early-onset group was not meeting clinical guidelines for testing frequency or targets. Future work is needed to inform tools and strategies to improve guideline recommended laboratory use in this group.
Sriskandarajah, A. (2023). Laboratory use in individuals with early-onset versus usual-onset of diabetes: a retrospective cohort study (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from