The best reward that I could get as a physician is if my patient was on 6 medications, and after six months I was able to bring them down to 5, 4, or maybe even 3 medications instead. That would be a reward for me and is what should be our target of focus as clinicians.
Over the years, I think we have forgotten about the true definition of health. We need to look back to the World Health Organization in the mid-40s that defined health as “not merely the absence of disease”, meaning a patient can look physically healthy; weight is perfect, BMI (Body Mass Index) is great, the muscle-to-fat ratio is great. But maybe there is something brewing.
Maybe the patient’s labs are creeping up and we need to take a look inside. We may see that there is a disease that could erupt over the coming weeks, months, or even years. We could stop this trend in healthcare, but the only way to do that is by collecting quarterly labs.
A 25-year-old comes into the clinician’s office to establish a relationship. As a routine, we would get baseline labs, which would likely include HbA1C. This is the Standard of Care and is used as a marker for pre-Diabetic screening. However, it is an absolute myth that A1C is a predictor of Diabetes. It is actually designed to evaluate the compliance of medications and diet once the patient has already been diagnosed. This is not to make a pre-Diabetic diagnosis.
A1C is a measurement of the RBC (Red Blood Cell) function and the amount of glucose that is on the RBCs. The RBCs in our blood only live for about 90-120 days. It’s a fallacy and a false satisfaction to the patient to think they aren’t at risk if their A1C is okay because it’s only a 90-day indicator.
What we should be measuring instead, for optimal diabetic care, is the insulin level. Why? We want to go to the factory where the insulin is produced- the pancreas. If we can see the function of the factory, we can ask ourselves, “is the factory getting tired?” If the pancreas produces an abundance of insulin, which is what stabilizes the blood sugar, for weeks, months, or years, eventually it becomes fatigued. That’s what we want to be able to see. The fasting insulin level can be drawn on a quarterly basis to see if there is an increase in insulin, and from there we can determine if a patient is at risk for Diabetes. A patient should be getting annual labs at the bare minimum, but ideally, they should get these labs quarterly, so the clinician can look for signs of early disease. It is optimal care for the patient to see if there is any reason to believe that they may be at risk.
No disease creeps up overnight. You weren’t healthy yesterday and got Diabetes or cancer today. It was a gradual process over time that could have been discovered if you were getting routine labs on a quarterly basis.
Kayur V. Patel, MD, MRO, FACP, FACPE, FACHE, FACEP