a1c testing

clinical laboratory history predictive value

Recent studies have demonstrated that an applicant’s clinical laboratory history is roughly twice as effective as a prescription history in identifying the highest levels of mortality risk. Clinical laboratory data also provides the ability to evaluate an applicant’s risk profile longitudinally. It can detect long-term trends in critical medical indicators such as A1c, PSA, and cholesterol—among many others—and minimizes the probability of reaching an inaccurate risk assessment based on a single outlier result. Upon receiving the applicant’s written consent, the enhanced clinical laboratory data product will provide access to laboratory test results for more applicants, supporting a more efficient and accurate underwriting process.

This white paper illustrates the various data sources available and the predictive value for identifying mortality risk associated with each data piece.

Download white paper

blood draw

We all know the routine. The examiner draws blood during a mobile exam. Delays in processing allow those hungry red blood cells to gobble up glucose. The underwriter sees an extremely low glucose reading or the dreaded not valid glucose (NVG) on the laboratory report. Or the laboratory report notes hemolysis is present. Then there are the results of a CBC where the blood was collected Friday afternoon, but not analyzed until Monday morning.

Now what? Does any of this matter to the underwriter?

What changes?

We used to think glycolysis was a seasonal issue. While it is more severe during the warm summer months, ExamOne data shows this issue is present throughout the year. But the question is: does very low glucose or not valid glucose still matter to life insurers?

With the majority of insurers now routinely testing A1c on every blood specimen, concerns with glycolysis are almost eliminated. A1c measures average blood glucose level for the preceding two to three months and is unaffected by glycolysis. Thus, it is a superior underwriting tool for measuring glucose control and is the recommended testing protocol for diagnosing diabetes by the American Diabetes Association.

Companies foregoing A1c testing must order a blood collection recheck or roll the dice and hope the applicant does not have a risk of glucose intolerance or diabetes.

What about hemolysis?

Hemolysis is the breakdown or rupturing of red blood cells. Hemolysis has a minor effect on a few blood analytes—particularly the aspartate aminotransferase (AST)—and is generally of minimal concern to the underwriter. Underwriters can feel comfortable underwriting specimens reported as having slight hemolysis.

Severe hemolysis, however, may have a significant effect on the AST, alanine transaminase (ALT), alkaline phosphatase (ALP), bilirubin, protein, triglyceride and glucose. If the hemolysis is too severe, the laboratory may result those analytes as “not valid – hemolysis” (NVH). Basing underwriting decisions on severely hemolyzed specimens can be risky.

Hemolysis and specimen processing delays can affect complete blood count (CBC) results by falsely decreasing or elevating a number of components in the CBC. Prompt processing of the CBC is critical, especially in cases where the underwriter orders the CBC “for cause.”

CBC results are fairly stable for approximately 72 hours at room temperature. Refrigerated specimens are stable even longer—for another two days. Delays in processing yield questionably accurate results, especially when evaluating anemic applicants.

Two options for reducing or eliminating glycolysis and hemolysis

According to ExamOne data, 15 percent of specimens are impacted by glycolysis and 4 percent are impacted by hemolysis. Advancements in testing protocol and availability of clinical exam centers have helped reduce the prevalence of specimen degradation.

specimen quality

A1c is stable for the life of the purple top tube—28 days—and it is unaffected by pre-analytic conditions such as heat and time, eliminating the risk of glycolysis. ExamOne’s routine risk assessment screen includes A1c testing so every specimen is tested upon arrival at the laboratory.

In addition to being a convenient option for applicants, exam centers provide a level of confidence unmatched in the life insurance industry. ExamOne data shows NVG rates of specimens drawn at exam centers are less than 0.1 percent, while NVH rates are less than 0.5 percent. Blood collected at an ExamOne or Quest Diagnostics exam center is processed and analyzed within 48 hours so the chances of specimen degradation due to temperature or processing delays are significantly reduced, giving insurers confidence they are basing underwriting decisions on accurate health insights.

Ask the Experts: Why A1c is the gold standard of diabetes testing

November 15, 2016 Ask The Experts

November is National Diabetes Month. Earlier this year we became the first laboratory in the insurance industry to update our insurance profile to include HbA1c (commonly referred to as A1c) testing for all life insurance applicants. By upgrading to this test, we will help insurers identify more applicants who are either diabetic or who may […]

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The growing diabetes crisis and what it means for life insurers

November 3, 2016 Carriers

The diabetic crisis continues to grow around the world, but despite its prevalence, it remains an almost invisible disease. The month of November is dedicated to bringing awareness to this chronic illness and a sense of urgency about this growing public health crisis. According to the World Health Organization, the number of people with diabetes […]

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The global diabetes crisis and what it means for life insurers

May 31, 2016 Carriers

According to the World Health Organization (WHO), the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.[1] Diabetes was attributable to 3.7 million deaths in 2012. Forty-three percent of all deaths due to high blood glucose occur before the age of 70.[1] Type 1 diabetes is most […]

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Diabetes Awareness Month: Using A1c as a Diabetes and Mortality Marker

November 6, 2015 Carriers

November is the start of Diabetes Awareness Month, an especially important event with the increasing numbers of those individuals with type 2 diabetes in the United States. According to the 2014 Diabetes Report Card, 29 million Americans are currently living with diabetes; there are about 8.1 million who are still undiagnosed. [1] Shockingly, diabetes causes […]

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Don’t fall victim to sleepless nights

October 31, 2015 Carriers

On Sunday, November 1st, we will “fall back” as daylight savings time comes to an end, and people across the country set their clocks back one hour and gain an hour of sleep. Nights get darker earlier, but are you getting enough sleep to match the longer nights? Currently, 40 million Americans suffer from chronic, […]

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