Have a laboratory medicine question you’d like to pose to AACC members? The Artery—AACC’s online community—allows users to leverage the collective expertise of thousands of laboratory medicine professionals. Searching through the Artery reveals posts on almost any topic imaginable. Based on Artery metrics, three challenging clinical laboratory topics were selected for presentation at an Artery 2019 Hot Topics session this morning: oral glucose tolerance testing, individualized quality control plans, and drugs of abuse immunoassay screening. Sean Campbell, PhD, Tiffany Roberts, PhD, and Danyel Tacker, PhD, will be presenting these topics respectively.

For as long as oral glucose tolerance testing has existed, clinical laboratories have been asked whether a glucose substitute can be used in place of the less palatable Glucola drink. The desire to find a better tasting substitute has even extended to the medical literature in which publications recommend how many jelly beans or Twizzlers, or how much apple juice can be used in place of Glucola. Campbell cautions that “any director or practitioner be very careful of Glucola alternatives and validating any results of an oral glucose tolerance test done with them.” The crux of the problem is that some glucose substitutes have been shown to significantly reduce sensitivity of oral glucose tolerance testing. In Campbell’s opinion, laboratories have a duty to ensure results are accurate and that means the entire process from specimen integrity to test results must be carefully controlled.

CLIA’s rollout in 2013 of the new quality control option called the Individualized Quality Control Plan (IQCP) has been challenging for laboratories precisely because it is a new control framework. Intended to be provide additional flexibility for laboratories to tailor their quality control plan for their specific laboratory and patient population, the number of Artery posts on IQCP reflects that this has been difficult for laboratories. Roberts says labs, “have been coming up with our QC based mostly on what feels right when it comes to a balance between cost and risk, but we have tools at our disposal to do this in a data-driven way and I will explore those tools in my talk.”

We’re all familiar with the opioid epidemic and the serious effects it has on healthcare. Urine drug screening by immunoassay is one example of how laboratories have been and continue to be impacted by drug testing. As Tacker will present, laboratories play a critical role in drug testing “not only in delivering the testing itself or connecting users to appropriate testing, but also in guiding clients through appropriate use of each type of test, troubleshooting when tests fail or when adulteration or doping are suspected, and consulting about next steps when results don’t match the clinical presentation.”

Each of these hot topics highlight the existing and emerging trends in clinical laboratories that keep lab professionals on their toes. We’re fortunate to have the Artery as a dynamic resource to virtually connect with experts in the areas that all of us find challenging.