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Avoiding Unnecessary Repeat Laboratory Testing.

Tarang Patel¹, Ethan Karle¹, Armin Krvavac²

¹Internal Medicine, University of Missouri Healthcare, Columbia, USA.

|November 26, 2019

Summary

This summary is machine-generated.

This case study highlights surreptitious exogenous insulin use causing refractory hypoglycemia. It underscores the significant issue of unnecessary laboratory testing and the need for improved clinical follow-up and system-based solutions.

Keywords:

cost-effective factitious disorder high value care laboratory testing surreptitious use of insulin

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Area of Science:

Endocrinology
Clinical Medicine
Medical Diagnostics

Background:

Refractory hypoglycemia in diabetic patients can stem from various causes, including surreptitious insulin administration.
Effective diagnosis relies on precise laboratory testing and careful interpretation of results, particularly insulin and C-peptide levels.

Observation:

A 44-year-old female with diabetes presented with recurrent, severe hypoglycemia.
Initial tests revealed elevated insulin and low C-peptide, indicating exogenous insulin use.
Despite initial diagnosis, repeat testing was performed due to incomplete record-keeping.

Findings:

Surreptitious exogenous insulin use was confirmed by the discrepancy between elevated insulin and inappropriately low C-peptide levels.
A significant percentage of laboratory tests are unnecessary, contributing to healthcare costs.
Failure to follow up on results and repeat testing are major drivers of medical waste.

Implications:

Implementing computer-based solutions can reduce duplicate and unnecessary laboratory tests.
Clinical education at the point of test ordering is crucial for optimizing diagnostic pathways.
Improving test result follow-up and reducing redundant testing are key to high-value medical care.