Identifying Metabolic Risk

Quest Diagnostics

Print

COVID-19

Quest Diagnostics

Doctor and patient

Metabolic conditions and COVID-19

Identifying metabolic risk is key in optimizing patient outcomes should they become infected with COVID-19

A recent study published in the journal Diabetes Care links metabolic syndrome and severe outcomes from COVID-19, noting significant increases in intensive care admissions, ventilation, acute respiratory distress syndrome (ARDS), and death among patients with metabolic syndrome vs those without metabolic syndrome1

Patients with metabolic syndrome

Patients without metabolic syndrome

Patients syndrome

Metabolic syndrome is defined by the National Heart, Lung, and Blood Institute as a group of factors increasing risk for heart disease, diabetes, stroke, and other health problems. Patients are said to have metabolic syndrome if they have 3 or more of the following conditions2:

covid-icon

Obesity

covid-icon

High levels of triglycerides

covid-icon

High blood pressure

covid-icon

Diabetes or prediabetes

covid-icon

Low levels of high-density lipoprotein (HDL)

 

Obesity and COVID-19

New data from the CDC confirms that obesity increases heightened risks from COVID-19. As well, adult obesity rates are rising nationwide with notable racial and ethnic disparities.

12 states had adult obesity rates of over 35%
in 2019 (up from 9 states in 2018 and 6 states in 2017)

34 states and the District of Columbia have obesity rates of over 35%
among African-American adults

15 states have obesity rates of over 35%
among Hispanic adults

6 states have obesity rates of over 35%
among non-Hispanic white adults

As obesity worsens outcomes from COVID-193, including chances of hospitalization and death, Quest’s Metabolic Risk panel can help you identify individuals most at risk for severe outcomes.

Diabetes and increased risks for COVID-19

The risks of severe outcomes for patients with diabetes who contract COVID-19 are well noted. The CDC states that type 2 diabetes increases the risk of severe illness from COVID-19, and that type 1 or gestational diabetes may also increase the risk.4

The International Diabetes Federation (IDF) notes the difficulty in treating viral respiratory infections such as COVID-19 due to fluctuations in blood glucose levels and possible diabetes complications. Two potential reasons for the severity of COVID-19 in patients with diabetes may be tied to compromised immune systems and the possibility that the virus may thrive in elevated blood glucose.5

Additionally, a recent letter in the New England Journal of Medicine notes that the inflammatory response associated with SARS-CoV-2 may impact preexisting diabetes risk.6

Success

Thank you
for your submission!

Fill out the form below to learn how we can work together to identify patients with increased risk

Thankyou!
*Required

Please note this form is intended for health care professionals

Respiratory viral infections and heart health

Cardiovascular disease (CVD) and other pre-existing conditions increase risk from respiratory viral infections such as COVID-19 and seasonal flu.

Quest can help you identify patients at increased cardiovascular risk.

LEARN MORE

Our Patient Service Centers put patient care first every day

Quest Diagnostics’ network of 2,250 Patient Service Centers (PSCs) provides essential testing services.

Watch

Watch how our PSCs are implementing enhanced safety precautions through our Peace of Mind program.

Set goals for your patients’ cardiometabolic health with 4myheart®

The 4myheart® program is an on-line personalized care platform designed to help patients improve and maintain cardiometabolic health. The service provides access to certified clinical educators who work with you to create a risk-reduction plan.

LEARN MORE

Obesity and COVID-19

New data from the CDC confirms that obesity increases heightened risks from COVID-19. As well, adult obesity rates are rising nationwide with notable racial and ethnic disparities.

12 states had adult obesity rates of over 35%

in 2019 (up from 9 states in 2018 and 6 states in 2017)

34 states and the District of Columbia have obesity rates of over 35%

among African-American adults

15 states have obesity rates of over 35%

among Hispanic adults

6 states have obesity rates of over 35%

among non-Hispanic white adults

As obesity worsens outcomes from COVID-193, including chances of hospitalization and death, Quest’s Metabolic Risk panel can help you identify individuals most at risk for severe outcomes.

Diabetes and increased risks for COVID-19

The risks of severe outcomes for patients with diabetes who contract COVID-19 are well noted. The CDC states that type 2 diabetes increases the risk of severe illness from COVID-19, and that type 1 or gestational diabetes may also increase the risk.4

The International Diabetes Federation (IDF) notes the difficulty in treating viral respiratory infections such as COVID-19 due to fluctuations in blood glucose levels and possible diabetes complications. Two potential reasons for the severity of COVID-19 in patients with diabetes may be tied to compromised immune systems and the possibility that the virus may thrive in elevated blood glucose.5

Additionally, a recent letter in the New England Journal of Medicine notes that the inflammatory response associated with SARS-CoV-2 may impact preexisting diabetes risk.6

 

Patients with diabetes are also at high risk from the flu

Complications from the flu can also be serious for people with type 1, type 2, or gestational diabetes. Some flurelated complications from diabetes include pneumonia, bronchitis, sinus infections, and ear infections. Changes in appetite related to flu complications can also result in swings in glucose levels.

30%

According to the CDC, 30% of hospitalizations reported during recent flu seasons were patients with diabetes7

Management of diabetes and glycated hemoglobin testing

covid-icon

While guidelines suggest regular monitoring of glycated hemoglobin (HbA1c) with a frequency of 2 to 4 times a year, a recent study by Quest researchers8 indicated that the COVID-19 pandemic and its related quarantines may have compromised diabetes management.

Compared to the previous 60 weeks, researchers noted that testing was down by as much as 66% during the first 8 weeks of March and April 2020. The researchers concluded that the drop in testing frequency might lead to increases in higher blood pressure and hyperlipidemia, as well as a higher risk of complications such as cardiovascular disease, microvascular complications, and myocardial infarction.8

Compared to the previous 60 weeks, researchers noted that testing was down by as much as 66% during the first 8 weeks of March and April 2020. The researchers concluded that the drop in testing frequency might lead to increases in higher blood pressure and hyperlipidemia, as well as a higher risk of complications such as cardiovascular disease, microvascular complications, and myocardial infarction.8

Patients with diabetes are at an increased risk for heart disease

The American Heart Association notes that people with diabetes are 2 to 4 times more likely to die from heart disease than people without diabetes—68% of people aged 65 or older who have diabetes die from heart disease and 16% from stroke. Patients with diabetes may have conditions that increase the risk for heart disease, such as hypertension, unhealthy cholesterol levels, obesity (which contributes to insulin resistance), and fluctuations in blood sugar levels.9

Patient Doctor Icon

Ensuring your patients with diabetes or prediabetes monitor their glycated hemoglobin at recommended frequency can help them better manage their insulin.

 

Identifying insulin resistance for early intervention

Patients at risk for insulin resistance (IR) may be difficult to diagnose without testing. Patients with normal glucose and HbA1c may be at risk10 as may individuals with the following clinical features:

  • Overweight/obese
  • Central obesity
  • Family history of diabetes
  • A history of gestational diabetes mellitus
  • Hypertension
  • Acanthosis nigricans

Insulin resistance is estimated to affect more than 60 million Americans.11 Testing for IR can help patients take action to prevent or delay the course of their prediabetes/diabetes.12

covid-icon

Patients can have normal glucose and HbA1c, but their beta cells may be struggling with glucose load, leading to IR, and subsequently prediabetes and diabetes

covid-icon

IR can be gradual and difficult to recognize12but patients can be identified while there’s still time to change course

covid-icon

IR is associated with cardiovascular disease (CVD), nonalcoholic fatty liver disease (NAFLD), and polycystic ovary syndrome (PCOS)12

 

How the laboratory can help

Quest Diagnostics and Cleveland HeartLab® provides tests to assist in the assessment and care of patients with underlying metabolic risk who are at increased risk for severe outcomes from COVID-19.

Test name Test code
Cardio IQ® Insulin Resistance
Panel with Scorea,b
36509
Cardio IQ® Hemoglobin A1ca 91732

aIf ordering through Cleveland HeartLab (CHL) use the following test order codes: Insulin Resistance Panel with Score (1388), Hemoglobin A1C (HbA1c) (C145)

bPanel components may be ordered separately. For CHL panel components: Insulin (C146), C-Peptide (C136). For Quest panel components: Insulin, Intact, LC/MS/MS (93103), C-Peptide (372)

 
Computer Icon

For more information on metabolic testing or a complete list of our tests, visit our test directory

Resource center

The following additional links provide more information on the risk factors of patients with diabetes and respiratory viruses such as COVID-19 and the flu:

paper Icon

Assessing Diabetes Risk

paper Icon

Cardio IQ® Insulin Resistance

References

  1. Xie J, Zu Y, Alkhatib A, et al. Metabolic syndrome and COVID-19 mortality among adult black patients in New Orleans [published online ahead of print August 25, 2020]. Diabetes Care. doi:10.2337/dc20-1714
  2. National Heart, Lung, and Blood Institute (NIH). Metabolic syndrome. Accessed October 1, 2020. https://www.nhlbi.nih.gov/health-topics/ metabolic-syndrome
  3. Centers for Disease Control and Prevention (CDC). CDC Newsroom. New CDC data finds adult obesity is increasing. Reviewed September 17, 2020. Accessed October 1, 2020. https://www.cdc.gov/media/releases/2020/s0917-adult-obesity-increasing.html
  4. Centers for Disease Control and Prevention (CDC). Coronavirus Disease 2019 (COVID-19). People with certain medical conditions. Updated September 11, 2020. Accessed October 1, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
  5. International Diabetes Federation (IDF). Coronavirus COVID-19. COVID-19 and diabetes. Updated August 27, 2020. Accessed October 1, 2020. https://www.idf.org/aboutdiabetes/what-is-diabetes/covid-19-and-diabetes/1-covid-19-and-diabetes.html
  6. Mozafari N, Azadi S, Mehdi-Alamdarlou S, Ashrafi H, Azadi A. Inflammation: a bridge between diabetes and COVID-19, and possible management with sitagliptin. ScienceDirect. 2020;143:110111. doi:10.1016/j.mehy.2020.110111
  7. Centers for Disease Control and Prevention (CDC). Influenza (flu). Flue & people with diabetes. Reviewed September 28, 2020. Accessed October 1, 2020. https://www.cdc.gov/flu/highrisk/diabetes.htm
  8. Fragala MS, Kaufman HW, Meigs JB, Niles JK, McPhaul MJ. Consequences of the COVID-19 pandemic: reduced hemoglobin A1c diabetes monitoring [published online ahead of print June 29, 2020]. Popul Health Manag. doi:10.1089/pop.2020.0134
  9. American Heart Association (AHA). Cardiovascular disease and diabetes. Reviewed August 30, 2015. Accessed October 1, 2020. https://www.heart.org/en/health-topics/diabetes/why-diabetes-matters/cardiovascular-disease--diabetes
  10. Abbasi F, Shiffman D, Tong CH, Devlin JJ, McPhaul MJ. Insulin resistance probability scores for apparently healthy individuals. J Endocr Soc. 2018;2(9):1050-1057. doi:10.1210/js.2018-00107
  11. American Heart Association (AHA). What is diabetes? Reviewed August 30, 2015. Accessed October 1, 2020. https://www.heart.org/en/health-topics/diabetes/about-diabetes
  12. Reaven GM. The insulin resistance syndrome. Curr Atheroscler Rep. 2003;5(5):364-371. doi:10.1007/s11883-003-0007-0