The Role of The Clinical Laboratory in Screening, Diagnosis and Monitoring of Diabetes Mellitus

The Role of the Clinical Laboratory in
Screening, Diagnosis and Monitoring

of Diabetes Mellitus
Dr. Miswar Fattah, MSi
Present by Miswar Fattah 2024

Changing Healtchcare Enviroment
Present by Miswar Fattah 2024 Kpmg 2018

Metabolome
Proteome

FUTURE
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"Medical Laboratory E
Scientists are the life We NEED Medtech

force of healthcare's
Sm ar t A SE A N
Professional to face
future." Present by Miswar Fattah 2024 future healthcare
10 Big trend in Laboratory Medicine
Point of care
testing and Predictive and Real-time Clinical decision
emerging at-home personal genetics diagnostics support solutions
diagnostic solutions
Data-driven lab
Artificial intelligence Cloud computing Digital pathology
optimization
in medical imaging and data integration and image analysis
solutions
Nanotechnology Smaller & Simple

and biosensors lab equipment

The four technological
waves of biochemical
monitoring

Role of LabTech in Clinical Laboratory
Validate/ Avoided Integrated

Preparat the
Select method verification Sampling preanalytical patient data
Sampel
method error with LIMS
Validate/ Maintained
Troubleshootin Maintained Testing of
Report results verificate Instrument/
g Quality sample
results reagent
Summarize Communicate Communicate

Publish
mothly results results limitation

Role of LabTech in Diabetes
Select method Choose

Understanding Validate/
Diabetes standardized kit Preparat the
Pathomechanis verification Sampling
related (NGSP, Sampel
of Diabetes method
kit/instruments traceable)
Maintained Integrated Avoided

Troubleshootin Maintained Testing of
Instrument/ patient data preanalytical
g Quality sample
reagent with LIMS error
Validate/
Summarize Communicate Communicate
verificate Report results Publish
mothly results results limitation
results

Diabetes
Dr. Miswar Fattah, MSi

Diabetes, Hyperglycemia

Glucose metabolism

Diabetes, Hyperglycemia

Glucose metabolism & Insulin function

Diabetes Patho Mechansims

Type of Diabetes
Specific types Gestational

Type 1 diabetes Type 2 diabetes of diabetes due diabetes
to other causes mellitus
, e.g., monogenic diabetes
syndromes (such as
neonatal diabetes and
maturity-onset diabetes of (diabetes diagnosed in the
(due to a non-autoimmune
(due to autoimmune b-cell the young), diseases of the second or third trimester of
progressive loss of
destruction, usually leading exocrine pancreas (such as pregnancy that was not
adequate b-cell insulin
to absolute insulin cystic fibrosis and clearly overt diabetes prior
secretion, frequently on the
deficiency, including latent pancreatitis), and drug- or to gestation or other types
background of insulin
autoimmune diabetes in chemical-induced diabetes of diabetes occurring
resistance and metabolic
adults) (such as with throughout pregnancy,
syndrome)
glucocorticoid use, in the such as type 1 diabetes).
treatment of people with
HIV, or after organ
transplantation)

1. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024 | Diabetes Care | American Diabetes Association
Inflammation & Type2 Diabetes

Insulin receptor & Type 2 Diabetes

Diabetes test

Diabetes

Prediabetes

Staging Type 1 Diabetes

TYPE 1 DIABETES
Screening for presymptomatic type 1

diabetes may be done by detection of
autoantibodies to insulin, glutamic acid
decarboxylase (GAD), islet antigen 2 (IA-2),
or zinc transporter 8 (ZnT8).
Having multiple confirmed islet

autoantibodies is a risk factor for clinical
diabetes. Testing for dysglycemia may be
used to further forecast nearterm risk.
When multiple islet autoantibodies are
identified, referral to a specialized center
for further evaluation and/or consideration
of a clinical trial or approved therapy to
potentially delay development of clinical
diabetes should be considered.
Standardized islet autoantibody tests are

recommended for classification of diabetes
in adults who have phenotypic risk factors
that overlap with those for type 1 diabetes
(e.g., younger age at diagnosis,
unintentional weight loss, ketoacidosis, or
short time to insulin treatment). E
Insulin Production & type 1 Diabetes

Impact of hyperglycemia

Preventive &
Wellness
Early detection
Screening
Diagnosis
Monitoring
Targeted Therapy

Type of Biomarkers
Pharmaco- Monitoring
Predictive, Early Diagnosis, genetics & Therapy &
Risk, detection & Confirmatory
& Staging
Targeted Prognostic
susceptibility Screening
Therapy

Type of Biomarkers
& Staging
Targeted Prognostic
Therapy
Diabetes Risk
Genetic

I IMMUNE RISK
Preventive Medicine
H HYPERTENSION RISK
DIABETES RISK
D (DIArisk)
N Nutrigenomics
VASCUL RISK
V (VASCULArisk)
C CANCER RISK (CArisk)

www.diabetes.org/risk-test

www.idf.org/type-2-diabetes-risk-assessment/

Type of Biomarkers
& Staging
Targeted Prognostic
Therapy
Diabetes Risk BCAA

Genetic OGTT
Quantose
HbA1c
BCAA
• Leucine
• Isoleucine
• Valine

Mass Spectrometry & Separation Science Laboratory
ICP MS LCMSMS
HPLC • Streoid Hormon
GCMS
• Nutritional Panel
simultane 16 element
UV/Fluoro Testosteron, 17 OH
Progesteron, Aldosteron, • Fatty acid
• Toxic Panel • Vitamin A
Androstenedione, etc
• 25OH Vitamin D2 & D3
profile
simultane 4 element
• Vitamin E • Inborn Error (Acylcarnitine- • ProHealthy Gut
• Aging Panel amino acid)
• Vitamin C
• Urine, hair, blood, • Immuno suppressant
serum trace element • Homocysteine (tacrolimus, cyclosporin,
sirolimus)
• Amino Acid profile
• Vit B1 B6

BCAA

The role of circulating amino acid levels for cellular function

Metabolomics in
Obesity and Diabetes

Quantose
• A Quantose IR Score is generated using a proprietary algorithm that

combines quantitative measures of α-hydroxybutyrate (AHB), oleic acid,
linoleoyl-glycerophospocholine (LGPC) and insulin
• α-Hydroxybutyrate (AHB) – an organic acid that may be a marker of fatty
acid oxidation and antioxidant glutathione synthesis (oxidative stress)
• Linoleoyl-glycerophosphocholine (LGPC) – a lipid that may be a marker of
fatty acid synthesis in the liver and inflammation
• Oleic acid – a free fatty acid that is a marker of lipolysis and total plasma
fatty acids

Gut
microbiome
Faecal Faecal
volatolomics metabolomics
Faecal Short
Faecal
Chain fatty
inflammation
acid
Present by Miswar Fattah 2024 Faecal - gold

Type of Biomarkers
& Staging
Targeted Prognostic
Therapy
Fasting Glucose
Diabetes Risk BCAA Pharmacoge-
Glucose CGM
Genetic TTGO netic HbA1c
TTGO Glycated Alb
Quantose
HbA1c HbA1c Fructosamin

They consulted intricately designed urine flavor charts
that described the sight, smell and taste of urine.

JCTLM

Spectrophotometry reference measurement
Glucose

Method glucose

A1c note

NGSP list
https://ngsp.org/docs/methods.pdf

Classification

Type of Biomarkers
& Staging
Targeted Prognostic
Therapy
Fasting Glucose
Diabetes Risk BCAA Pharmaco
Glucose
TTGO HbA1c
Genetic TTGO ge-netic Glycated
Quantose HbA1c
Alb
HbA1c Fructosami
n
Glycation Process

Hb

Glycation Hb A1c

Hba1c

Impact glycated hemoglobin

HbA1c, boronate

The differences of reflecting period for
glycemic control

Hba1c

Hba1c electrophoresis

Hba1c methodology

Hba1c standarization

Glycated albumin

Usefulness of Glycated Albumin as indicator
for efficacy of therapy

Limitation of glycation markers

Glycated alb

GA and other monitoring markers

Glycated albumin vs hba1c

Glucose monitoring

Glucometer evolution

92 mg/dL

Entire Stages of diabetes care

Ambulatory glucometer

An example of an ambulatory glucose profile
report.

Evolution glucometers

Sticker glucometer

Implant Glucometer

TO FACE EMERGING TECHNOLOGY WE NEED TO LOOKING THE FUTURE

Perbanyak melihat Jendela Kehidupan
Dengannya kita akan lebih mudah termotivasi
Menggapai impian yang lebih baik

Meeting the Challenges of Precision Medicine:
Leveraging High Competency in Laboratory Medicine

Preparing for Tomorrow's Challenges: Closing the
Competency Gap

Thank you

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The Role of the Clinical Laboratory in

Screening, Diagnosis and Monitoring

Dr. Miswar Fattah, MSi

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024 Kpmg 2018

Present by Miswar Fattah 2024

Scientists are the life We NEED Medtech

Nanotechnology Smaller & Simple

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Validate/ Avoided Integrated

Summarize Communicate Communicate

Present by Miswar Fattah 2024

Select method Choose

Maintained Integrated Avoided

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Specific types Gestational

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Screening for presymptomatic type 1

Having multiple confirmed islet

Present by Miswar Fattah 2024

Standardized islet autoantibody tests are

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

C CANCER RISK (CArisk)

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Diabetes Risk BCAA

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

• A Quantose IR Score is generated using a proprietary algorithm that

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024 Faecal - gold

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024

Present by Miswar Fattah 2024