Initial Laboratory Evaluation for Newly Diagnosed Diabetes

Baseline Tests at Diagnosis

Order HbA1c, fasting plasma glucose (if not already performed), a lipid panel, serum creatinine with estimated glomerular filtration rate (eGFR), and a urine albumin‑to‑creatinine ratio as the initial laboratory work‑up for adults with newly diagnosed diabetes. [1][2]

HbA1c measurement is mandatory at diagnosis and must be performed with an NGSP‑certified method in an accredited laboratory. [1][3]
When diabetes is diagnosed by glucose testing alone, confirm the diagnosis with an HbA1c; when diagnosed by HbA1c alone, confirm with a fasting plasma glucose ≥ 7.0 mmol/L (≥ 126 mg/dL). 2
Repeat HbA1c every 3 months until the individualized glycemic target is reached, then at least every 6 months thereafter. [1][3]
For most non‑pregnant adults, aim for an HbA1c < 7 % (< 53 mmol/mol); schedule HbA1c checks every 3 months until this target is achieved, then every 6 months. [1][3]

Measure serum creatinine with eGFR at baseline to assess kidney function and to guide selection of glucose‑lowering medications. 1

Obtain a fasting lipid panel (total cholesterol, LDL‑C, HDL‑C, triglycerides) at diagnosis to evaluate cardiovascular risk and to inform statin‑therapy decisions. 1

Use blood beta‑hydroxybutyrate measurement (rather than urine nitroprusside‑based tests) when diabetic ketoacidosis is suspected. [1][3]
Educate patients with type 1 diabetes or those receiving SGLT2‑inhibitors to perform ketone testing during unexplained hyperglycemia or when symptoms suggest ketosis. [1][3]

Do not use urine glucose testing for routine diabetes management. [1][3]
Establish annual screening for microvascular complications (retinopathy, nephropathy, neuropathy) after the initial laboratory evaluation. 1