A1c Testing as a Screen for Impaired Glucose Tolerance and Diabetes – Potential for Anti-Selection?

Many clients are currently including A1c as part of a screening blood profile, but those that aren’t may be leaving themselves open to anti-selection. Multiple internal A1c pilots have shown that anywhere from 8-33% of applicants with normal serum glucose, fructosamine, and urine glucose will have A1c > 6%.

The American Diabetes Association recently published new guidelines for diagnosing and treating Diabetes as a supplement to the January issue of Diabetes Care (http://care.diabetesjournals.org/content/33/Supplement_1). One of the biggest changes was the recommendation that A1c now be used to diagnose pre-diabetes and diabetes. Studies have shown that approximately 25% of type 2 diabetics do not know that they have the disease. And more efforts need to be made to screen for the disease. There are numerous advantages to using A1c to perform screening.  A1C is a better index of glycemic exposure than blood glucose, is at least as good at predicting risk of long-term complications, has similar if not better standardization, and is better in its lack of day to day variability. The new ADA guidelines suggest who should be tested for diabetes, and with the renewed emphasis on preventative medicine they will likely be followed by most primary care physicians. The guidelines suggestion on who should be tested is as follows:

 Criteria for testing for diabetes in asymptomatic adult individuals

1. Testing should be considered in all adults who are overweight (BMI _25 kg/m2*) and have additional risk factors:

• physical inactivity
• first-degree relative with diabetes
• members of a high-risk ethnic population (e.g., African American, Latino, Native American, Asian American, Pacific Islander)
• women who delivered a baby weighing _9 lb or were diagnosed with GDM
• hypertension (_140/90 mmHg or on therapy for hypertension)
• HDL cholesterol level _35 mg/dl (0.90 mmol/l) and/or a triglyceride level _250 mg/dl (2.82 mmol/l)
• women with polycystic ovary syndrome
• A1C _5.7%, IGT, or IFG on previous testing
• other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans)
• history of CVD

2. In the absence of the above criteria, testing diabetes should begin at age 45 years

3. If results are normal, testing should be repeated at least at 3-year intervals, with consideration of more frequent testing depending on initial results and risk status.” (1)

The new guidelines also state that: “Individuals with an A1C of 5.7–6.4% should be informed of their increased risk for diabetes as well as cardiovascular disease and counseled about effective strategies, such as weight loss and physical activity, to lower their risks. As with glucose measurements, the continuum of risk is curvilinear, so that as A1C rises, the risk of diabetes rises disproportionately. Accordingly, interventions should be most intensive and follow-up should be particularly vigilant for those with A1C levels above 6.0%, who should be considered to be at very high risk.” (2) One prospective study showed that 88% or those with A1c 5.7-6.4% will develop diabetes within 6 years without weight loss or exercise programs. Regarding the diagnosis of diabetes, the guidelines state: “A1C assays are now highly standardized so that their results can be uniformly applied both temporally and across populations. In their recent report, an International Expert Committee, after an extensive review of both established and emerging epidemiological evidence, recommended the use of the A1C test to diagnose diabetes, with a threshold of _6.5%, and ADA affirms this decision. The diagnostic A1C cut point of 6.5% is associated with an inflection point for retinopathy prevalence…” (2)

These new ADA guidelines will likely result in more individuals being aware of their A1c value, and if it is elevated, they might be in a position to anti-select against companies who are not testing. 

References:

1. Diabetes      Care January      2010 33:S11-S61

2. Diabetes Care January 2010 33:S62-S69

ExamOne University Announces Spring Webinar Schedule

The Benefits of Corporate Wellness Programs

Is your company actively partnering with its employees to improve their health and contain healthcare costs?  ExamOne’s health and wellness expert, Fred Williams, explores the benefits of corporate wellness programs and how instituting a wellness program can be a win-win for your company and its employees.

• Topic: The Benefits of Corporate Wellness Programs
• When: Thursday, April 22, 2010
• Time: 1 - 2 p.m. Central Daylight Time
• Duration: 45 +/- minutes with 15 minutes of QA
• Presenter: Fred Williams, Director of Health Management Strategies, Quest Diagnostics

About the Presenter

Fred is responsible for the development and promotion of health management strategies, especially focused on wellness, early detection, and risk reduction policies for the Employer Solutions Division of Quest Diagnostics. He has over 30 years experience with all facets of employee benefits management as well as cultural and change management issues. As Quest Diagnostics has increasingly pursued the business of wellness, prevention, and e-medical records, it has provided ample opportunity to offer and evaluate alternative health opportunities for its own employees. Fred led Quest Diagnostics to the early adoption of a consumer directed health plan, and launched HealthyQuest, an internal initiative designed to more fully engage individuals in improving their health and adding quality years to their lives.

He is currently a member of the NBGH National Leadership Committee on Consumer Directed Healthcare, and Chair of the Sub Committee on Consumer tools, a member of the Board of Directors of the Center for Value Based Health, a member of the HERO Think Tank, and  a member of the National Workforce Health Economics Advisory Board. Fred has a B.A. in economics from the University of Virginia.

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ExamOne Achieves SAS 70 Certification, Further Assuring Client's That Applicant Information is Protected

ExamOne is pleased to announce that it has obtained a SAS 70 Type II Certification, further assuring clients that their applicants’ personal information is protected.

Obtaining this certification required that ExamOne undergo an examination by and satisfy an independent auditing firm that the controls tested were suitably designed and operating with sufficient effectiveness to support their opinions. A SAS 70 certification is obtained by service organizations who wish to provide their clients with third-party assurance that they have effective internal controls to protect their clients’ data and is issued pursuant to standards established by the American Institute of Certified Public Accountants (AICPA).

“The applicant is at the center of everything we do and this certification demonstrates our commitment to protect applicant’s data,” commented Troy Hartman, Executive Director of Insurance Services. “Our clients invest a significant amount of time to ensure their service providers meet their internal security requirements. This certification saves them time and money in their efforts to ensure their customers personal information is secure. The assurance provided by the SAS 70 certification is something our clients should expect from all their partners.”

What is the SAS 70 auditing standard, and why should I care?

The SAS 70 ("Statement on Auditing Standards No. 70") is an internationally recognized standard to provide a means for our clients who are subject to Sarbanes-Oxley (Section 404) to evaluate the effectiveness and significance of their service provider’s controls. Additionally, SAS 70 has been designated by the SEC as an acceptable method for the management at such companies to obtain assurance about a service organization’s internal controls without conducting separate assessments. This results in significant audit cost savings for both parties.

Why did ExamOne seek a SAS 70 Type II Certification?

A SAS 70 Type II Certification is a market differentiator.  Many companies make the availability of a SAS 70 report a prerequisite for engaging a service provider.  This certification also represents our commitment to providing the next level of service and IT security for our clients and includes significant audit cost savings for them. With this certification, our clients can be confident that ExamOne services operate under reasonable controls, and that our systems are secure, reliable and compliant with evolving regulatory mandates.

What are the benefits of the ExamOne SAS 70 Type II Certification to our clients?

• Required by law: SAS 70 supports Sarbanes-Oxley Section 404 requirements and is designated by the SEC as an acceptable method to obtain assurance about a service organization’s internal controls.
• Reduces audit costs and speeds due diligence: a SAS 70 Type II report may be accepted in lieu of conducting a separate audit of a service provider.
• Provides control and assurances: a SAS 70 audit represents that a service provider has been through an in-depth audit of their control activities, which generally includes controls over information technology and related processes.
• A SAS 70 Type II audit can only be performed by a certified CPA firm who must adhere to specific professional standards established by the American Institute of Certified Public Accountants (AICPA).  ExamOne selected Ernst & Young, as one of accounting's Big Four and a firm with extensive SAS 70 expertise to conduct their SAS 70 Certification.

MIB Solutions and ExamOne Agree to Identify Methods to Jointly Address Life Insurance Industry Issues

MIB Solutions and ExamOne formed a strategic alliance with a mission to identify ways to provide value-added analytics and innovative research for the life insurance industry.  Both companies have demonstrated strong research and analytical capabilities.  Together, we have the means and the data sources to provide unique analytics to our overlapping member/client base in the life insurance industry. 

Each firm has a strong background in studying the mortality implications of specific medical impairments and the protective value of specific risk assessment tools.  Studies on particular risk classes or product types with larger datasets will be expected to provide the valuable insights previously unavailable.

MIB Solutions and ExamOne will be reaching out to MIB members and ExamOne clients to describe our working relationship in more depth.    Through this market research, innovations will be identified that can potentially improve risk assessment and mortality experience.

ExamOne Releases New CaseView Web Version and Introduces Improved Process for Managing Sensitive Results

ExamOne is pleased to release a new version of CaseView Web. The new release introduces several features designed to improve your workflow, including:

• Enhanced support model will provide faster response and problem resolution
• New client administrator role gives you more control
• Customization of services allows you to modify services and control how your services are displayed

As part of the enhanced security and advanced user control, ExamOne is introducing a new process for delivering sensitive results. Beginning with your migration to CaseView Web, all sensitive results will be delivered to CaseView Web — dramatically reducing delivery time of sensitive results and ensuring confidentiality. The CaseView Web security model ensures only users with appropriate permissions, as established by your client administrator, are able to view sensitive results.

CaseView Web can be accessed  from any PC with an Internet connection and a supported web browser.  Supported web browsers include Internet Explorer 6 Service Pack 1 and later or Firefox 3.0 and later.  If you use one or more CaseView PC or Citrix sites, ExamOne will contact you in the coming months to begin the migration process to CaseView Web.  Clients requiring hardware upgrades or experiencing hardware failures will be immediately transitioned to CaseView Web.

If you have any questions, please contact your ExamOne Regional Sales Vice President or technical account manager for more details.

March is Colorectal Cancer Awareness Month

Did you know that colorectal cancer is the third most common cancer and the third leading cause of cancer deaths? To raise awareness of this deadly disease March has been declared Colorectal Cancer Awareness month.  In the U.S., there are approximately 150,000 new cases of colorectal cancer per year and approximately 50,000 deaths¹. It’s often called the “silent killer” since many are symptom free and not diagnosed until late stages.

However, there is some positive news about colorectal cancer — it is largely curable if detected early. Quest Diagnostics offers an effective screening that is simple and easy. InSure® FIT™ is only offered by Quest Diagnostics and studies show that it is better at detecting stages I-III colorectal cancer compared to the traditional Hemoccult stool test².

Innovative companies and concerned individuals are taking action and participating in colorectal cancer screenings. If your company is interested in finding out how to help reduce healthcare costs and help save lives through early detection please call Quest Diagnostics at 1-800-654-7824 or contact us at our website www.blueprintforwellness.com.

References

1American Cancer Society Fact and Figures

2Cancer 2006 107(9)2152-59)