Diabetes*
Type 2 diabetes is often not diagnosed until complications appear. In fact, as many as 25% of patients with diabetes may not know they have it. Over 65 million adults in the U.S. are pre-diabetic, at a stage where lifestyle modifications may delay or prevent onset of type 2 diabetes, yet fewer than 10% of them know it.1
Patients who exhibit the metabolic syndrome are often insulin resistant and have significant changes in their lipoprotein concentrations and sizes. Lipoprotein abnormalities are exhibited in many of these patients even before glucose levels are elevated.2 Early detection means early intervention.
LipoScience offers an early indicator of insulin resistance, the Lipoprotein Insulin Resistance (LP-IR) Score. The LP-IR score is an assessment of insulin resistance, on a scale ranging from 0 (most insulin sensitive) to 100 (most insulin resistant), that combines the results of 6 lipoprotein particle numbers and sizes based on their differential strengths of association with insulin resistance.
LipoScience is taking the next step beyond pattern recognition in the current Metabolic Syndrome patient. The combination and weighting of these 6 markers allows LipoScience to give an improved assessment of insulin resistance and diabetes risk.
ADA 2010 guidelines recommend:
- Testing to “detect pre-diabetes and type 2 diabetes” in asymptomatic people should be considered in adults of any age who are:
- overweight or obese (BMI ≥25 kg/m2)
- who have one or more additional risk factors for diabetes
- Testing in those without risk factors, over the age of 45
- In those identified with pre-diabetes, if appropriate, to treat other cardiovascular disease (CVD) risk factors
* The LP-IR score is performed in LipoScience's CLIA certified laboratory.
1. Insulin Resistance and Pre-Diabetes. 2008. U.S. Department of Health & Human Services. NIH Publication No. 09-4893. Available from www.diabetes.niddk.nih.gov. 2. Mora et al. Diabetes. 2010;59:1153-1160.
The Pathway to Diabetes*
Development of type 2 diabetes is known for being symptomless until elevated or even slightly elevated glucose levels are detected during routine physicals.
The bad news is that rising glucose levels are a late symptom in the process. Well before insulin levels begin to rise, the body’s cells become increasingly resistant to the action of insulin. The pancreas responds by working to increase insulin production leading to possible eventual beta cell dysfunction.
The good news is that there is an earlier indicator of developing insulin resistance, lipoprotein abnormalities. Well before elevations in insulin production or glucose levels are identified, changes in lipoprotein metabolism have been occurring.
These changes include:
- Increasing numbers of large VLDL particles
- Increasing numbers of small LDL particles
- A drop in large HDL particles
- Changes in overall particle sizes of VLDL, HDL and LDL.
Lipoprotein Particle Concentration and Size analysis by NMR enables clinicians to detect these lipoprotein changes well before the onset of pre-diabetes, while there is still time to intervene in the pathway with lifestyle changes that may prevent or delay the onset of type 2 diabetes.
Early detection means early intervention.
Image adapted from The American Diabetes Association. Cardiometabolic risk: evaluation & treatment in your patient population. (2010). Retrieved from http://professional.diabetes.org/ResourcesForProfessionals.aspx?typ=17&cid=60397
* The LP-IR score is performed in LipoScience's CLIA certified laboratory.
Diabetes* and Cardiovascular Disease
The Link Between Type 2 Diabetes and Cardiovascular Disease – Cardiometabolic Risk
Cardiometabolic Risk (CMR) combines overall cardiovascular disease (CVD) risk resulting from both traditional risk factors such as age, sex, smoking, high blood pressure, and decreased HDL cholesterol with insulin resistance/diabetes and the additional risks of abdominal obesity, physical inactivity and related features of the metabolic syndrome.
Together, this cluster of risk factors called CMR, increases a patient’s risk of developing cardiovascular disease (CVD) and type 2 diabetes (T2DM). In order to properly evaluate and manage CVD risk in clinical practice, these factors should be taken into account.
- increased age (men over 35 years, women over 45 years)
- elevated blood pressure (> 130 / > 85 mmHg or on antihypertensive medication),
- abdominal obesity (waist circumference in men > 40 inches and women > 35 inches)
- elevated triglycerides (> 150 mg/dL)
- low HDL-C (men < 40 mg/dL, women < 50 mg/dL)
- elevated fasting blood glucose(> 110 mg/dL)
- increasing insulin resistance (IR)1
* The LP-IR score is performed in LipoScience's CLIA certified laboratory.
1. Brunzell et al. Lipoprotein Management in Patient with Cardiometabolic Risk. Consensus statement from the American Diabetes Association and the American College of Cardiology Foundation. Diabetes Care April 2008 (31);4: 811-821.
How to Order the Test*
Please contact our Client Services department toll-free at (877) 547-6837 to get started.
Clinician Resource Program - Share and gather case study information on real patients. LipoScience offers a free case study resource program for clinicians. Whether you want to share an interesting case study, or ask an expert about management options for your patients, the Clinician Resource Program provides this opportunity by offering a free, one-on-one peer teleconference. To speak with an expert about the NMR LipoProfile test, please contact inquiries@liposcience.com.
* The LP-IR score is performed in LipoScience's CLIA certified laboratory.
Understanding the Results
Lipoprotein Markers Associated with Insulin Resistance and Diabetes* Risk
This section includes the six lipoprotein markers associated with insulin resistance and diabetes risk, and are included in the calculation for the LP-IR score.
Lipoprotein Insulin Resistance (LP-IR) Score
The LP-IR score assesses the patient's insulin resistance level and diabetes risk. This score (0-100) is derived using the results from the six lipoprotein markers above. Therapeutic lifestyle changes may reduce the score.4,5
Improved diet and exercise is an important part of a patient's overall heart health and may lower LDL particle number. LipoScience developed a resource based on the well documented Mediterranean diet, with easy exercise tips, to help your patients adopt a heart healthy lifestyle. Click here to download the brochure.
* The LP-IR score is performed in LipoScience's CLIA certified laboratory.
1. Garvey WT et al. Diabetes. 2003;532:453-462. 2. Goff DC et al. Metabolism. 2005;54:264-270. 3. Reference population comprised 4,588 men and women not on lipid medication enrolled in the Multi-Ethnec Study of Atherosclerosis (MESA). 4. Genuth and Kahn. Diabetes Care. 2008;31:1096-1096. 5. Insulin Resistance and Pre-Diabetes. 2008. U.S. Department of Health & Human Services. NIH Publication No. 09-4893. Available from www.diabetes.niddk.nih.gov.
Reimbursement
The test is reimbursed by Medicare and many other health insurance plans.
Your laboratory service provider may offer additional access to managed care members. Please contact your laboratory service provider for more information. If you have questions, a LipoScience Insurance Specialist is available toll free:
866-547-0245
Monday through Friday (8:30am through 5:00pm ET).
Events
CVC Cardio Care Update
Scottsdale, AZ
Baptist Health Cardiovascular Disease Prevention
Miami Beach, FL
National Lipid Association (MWLA & PLA)
San Diego, CA
American College of Cardiology Meeting (ACC)
Chicago, IL
Carolina Clinical Connection
Charlotte, NC
2012 National Lipid Association Scientific Sessions
Scottsdale, AZ
American Diabetes Association (ADA)
Philadelphia, PA
South Carolina AFP Meeting
Pawley's Island, SC
American Association of Clinical Chemistry (AACC)
Los Angeles, CA
National Lipid Association (SELA & NELA)
Charlotte, NC
American Academy of Family Physicians (AAFP)
Philadelpia, PA
Online Results
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