Unveiling Self-Collected Diagnostics Supporting Weight Management Care
MTL Offers Medication Adherence Testing for GLP-1 Weight Management Monitoring
“Through meticulous analysis, we’re unraveling the intricate complexities of GLP-1, paving the way for tailored therapeutic interventions that redefine patient care.”
—Charles Sailey, MD, MS, FCAP, FASCP
Chief Scientific Officer and Medical Director of Laboratories
What Providers Should Know About Weight Management Testing
About The Test
The GLP-1 Adherence Monitoring Testing is designed to help maximize weight loss results while ensuring efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for glucose control and cardiometabolic parameters. These tests assist the clinician in tracking potential changes in glycemic control, insulin sensitivity, lipid levels, thyroid function, and renal efficiency. The information gained from these tests provides an understanding of how a patient’s weight management plan could be impacting their overall health, while using this information to potentially make necessary medication dose adjustments or modifications to diet and/or exercise. Tracking progress while minimizing related risks through diagnostic testing plays a crucial part in developing personalized long-term weight management plans.
When To Use
Once initial baseline screening has been established and weight loss therapy with GLP-1 drugs are initiated, the GLP-1 Adherence Monitoring Test could be ordered approximately once every three months as part of the required monitoring of glycemic control, metabolic parameters related to efficacy, and risk of adverse events.Test Features
Samples are self-collected in the convenience of a patient’s home using a dried blood spot (DBS) sampling technique. DBS sampling has a lot of advantages in comparison with “standard” venous blood collection, such as requiring a small sample collection volume that is easy to collect with no training necessary, being minimally invasive, and being stable and transportable at ambient temperature. The clinical utility of DBS sampling has improved diagnostics and care in hard-to-reach populations, at-risk populations, and people living in low-income settings.
- Monitor glycemic control to prevent disease progression of type 2 diabetes mellitus (T2DM) while reducing the risk of associated vascular complications.
- Assist in identifying individuals with prediabetes or developing insulin resistance to make lifestyle changes necessary to prevent the onset of T2DM and associated conditions.
- Follow metabolic progress with changes in lipid parameters to make necessary therapeutic changes or dose adjustments.
- Assist in identifying individuals at high risk of cardiovascular disease (CVD) to initiate appropriate monitoring and lifestyle changes.
- Track renal function and signs of dehydration as rapid weight loss can be associated with fluid and electrolyte imbalance.
- Note signs of potential increased muscle wasting to make necessary adjustments in diet and strength training activities.
- Help monitor for changes in thyroid function and sensitivity to thyroid hormone, as obesity and type 1 and type 2 diabetes are closely linked to thyroid dysfunction.
Test Benefits
GLP-1 Market: Self-Collected Diagnostics & Monitoring
WHY / when should i test for this?
After the initial baseline screening, these GLP-1 Adherence Monitoring Tests could be part of an ongoing screening process to ensure both safety and efficacy of GLP-1 treatment. These tests can be ordered as soon as every three months. However, follow-up intervals will vary depending on the patient, their overall health condition, and their individual weight loss and HbA1c goals.
GLP-1 Monitoring and Measurement
Laboratory testing plays a crucial role in monitoring patients on GLP-1 RAs for weight loss to ensure both efficacy and safety of the treatment plan. We offer on-going testing solutions to track important measures while on weight loss medications such as GLP-1 agonists. The biomarkers recommended for each patient population are outlined below:
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HbA1c
Hemoglobin A1c (HbA1c) measures a patient’s average level of glycemic control; HbA1c should be tested regularly for all diabetic patients. Diabetic patients are expected to routinely monitor glucose levels throughout the day, while HbA1c is an indicator of Time in Range (TIR) over two to three months. Achieving and maintaining HbA1c goals are critical in preventing disease progression and reducing the risk of diabetic vascular complications.
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Total Cholesterol (TC)
Total Cholesterol (TC) is a measure of the sum of cholesterol (HDL, LDL, VLDL) in the body. It is part of the lipid panel, commonly used to identify individuals at high risk of cardiovascular disease (CVD).
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Glucose
Fasting Plasma Glucose (FPG) is used to screen for diabetes. The risk of developing type 2 diabetes increases with increasing fasting glucose, even within the normal range of 99mg/dL. Fasting glucose of 100-125mg/dL typically indicates prediabetes. Levels 126mg/dL are indicative of diabetes. The utility of FPG is only for individuals without a current diagnosis of diabetes.
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HDL-Cholesterol
High-Density Lipoprotein (HDL) Cholesterol is known as “good” cholesterol because it removes excess cholesterol from circulation, reducing the risk of cardiovascular disease and stroke. Impaired insulin sensitivity leads to a reduction in HDL cholesterol, associated with an increased risk of cardiovascular disease (CVD).
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TSH
Thyroid-Stimulating Hormone (TSH) is used to screen for thyroid disorders. Diabetic patients have a high prevalence of thyroid dysfunction. Insulin resistance and hyperinsulinemia can lead to goiter, proliferation of thyroid tissues, and an increased incidence of nodular thyroid disease. Therapy with GLP-1 drugs has resulted in significant reductions of TSH in patients with diabetes and obesity, due to weight loss and improved sensitivity to thyroid hormone. Therefore, close monitoring of TSH is necessary to make appropriate medication dose adjustments.
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LDL-Cholesterol
Low-Density Lipoprotein (LDL) Cholesterol delivers cholesterol to inflammatory cells in blood vessels and is linked to atherosclerotic vascular disease, also known as “bad” cholesterol. Impaired insulin sensitivity leads to an increase in free fatty acids, resulting in elevated LDL cholesterol.
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Insulin
Fasting Insulin has been correlated with insulin resistance in non-diabetic patients. Insulin resistance precedes the development of type 2 diabetes by several years. Lifestyle modifications can reverse insulin resistance, attenuating the risk of developing diabetes and associated vascular conditions The clinical utility of fasting insulin is only for individuals without a current diabetes diagnosis, as fasting insulin is not associated with disease progression once diabetes has developed.
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Triglycerides
Triglycerides (TG) are a type of lipid in the blood used for energy. High triglyceride levels have consistently been linked with cardiovascular disease and stroke, especially when combined with low HDL levels and in patients with type 2 diabetes. Impaired insulin sensitivity leads to an increase in free fatty acids and increased TGs.
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Creatinine
Serum Creatinine (SrCr) reflects kidney damage and is related to body weight. Creatinine is a waste product from skeletal muscle metabolism, and it is filtered by the kidneys. Weight loss often leads to reduced muscle mass and therefore lower levels of creatinine. Since skeletal muscle is the major target for glucose-dependent insulin uptake, excessive muscle loss leads to a reduction of targets for insulin, increasing the risk of insulin resistance and the development of type 2 diabetes. Creatinine should be monitored throughout therapy to track changes in renal function and make necessary lifestyle modifications to improve insulin resistance and prevent excessive muscle loss.
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TC:HDL Ratio
TC:HDL Ratio is obtained by dividing a patient’s total cholesterol number by their HDL cholesterol number. Variations in the TC:HDL ratio have been associated with metabolic alterations related to insulin resistance and predictive of ischemic heart disease risk.
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eGFR
Estimated Glomerular Filtration Rate (eGFR) is used to measure renal function. It is calculated from the patient’s serum creatinine, age, body size, and sex. Renal function should be monitored in patients treated with GLP-1 RAs when initiating or escalating doses. GLP-1 drugs influence renal physiology with indirect metabolic and hemodynamic actions that might reduce renal risk in diabetic patients. However, acute kidney injury has occurred in patients treated with GLP-1 drugs. The initial stages of kidney disease often present without symptoms, and once symptoms develop, the kidneys are nearing failure. This makes eGFR a valuable diagnostic tool, as early detection allows for measures to preserve kidney function and prevent further decline.
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References
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- Hu W, Song R, Cheng R, Liu C, Guo R, Tang W, Zhang J, Zhao Q, Li X, Liu J. Use of GLP-1 Receptor Agonists and Occurrence of Thyroid Disorders: a Meta-Analysis of Randomized Controlled Trials. Front Endocrinol (Lausanne). 2022 Jul 11;13:927859.
- Muskiet MHA, Tonneijck L, Smits MM, van Baar MJB, Kramer MHH, Hoorn EJ, Joles JA, van Raalte DH. GLP-1 and the kidney: from physiology to pharmacology and outcomes in diabetes. Nat Rev Nephrol. 2017 Oct;13(10):605-628.
- Patel J, et.al. Current Diabetes Reviews, Volume 10, Number 4, 2014, pp. 238-250(13).
- Lemieux I, Lamarche B, Couillard C, et al. Total Cholesterol/HDL Cholesterol Ratio vs LDL Cholesterol/HDL Cholesterol Ratio as Indices of Ischemic Heart Disease Risk in Men: The Quebec Cardiovascular Study. Arch Intern Med. 2001;161(22):2685–2692.
- C Weyer, R L Hanson, P A Tataranni, C Bogardus, R E Pratley; A high fasting plasma insulin concentration predicts type 2 diabetes independent of insulin resistance: evidence for a pathogenic role of relative hyperinsulinemia. Diabetes 1 December 2000; 49 (12): 2094–2101.
- Laakso M, How Good a Marker Is Insulin Level for Insulin Resistance?, American Journal of Epidemiology, Volume 137, Issue 9, 1 May 1993, Pages 959–965.
Laboratory testing plays a crucial role in monitoring patients on GLP-1 RAs. Partner with MTL to Support Your Medication Adherence Testing
Don’t let poor GLP-1 medication adherence hinder the delivery of high-quality diabetes and weight management care for your patients. Partner with Molecular Testing Labs and leverage our expertise, advanced analytics, and testing panel to address GLP-1 adherence gaps efficiently and effectively.
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