Fasting Lipid Profile in Type 2 Diabetes- Necessity or Redundancy.

Diabetes mellitus is characterized not only by alteration in glucose insulin axis but marked features described as the diabetic dyslipidemia. The increased lipid level and total cholesterol synthesis during hyperglycemia may contribute to the acceleration of atherosclerosis in diabetes mellitus. Majority of guidelines currently recommend a fasting serum lipid for achieving consistency. It is also because majority of research has been performed using fasting lipids, it was assumed that making comparisons and analyzing risk would be less precise if using non-fasting tests. Fasting requirements are difficult for diabetics due to hypoglycemia and can reduce adherence with testing requests, delay results and place strain on testing facilities as a large influx of patients present for testing each morning.
Material: 100 known cases of type-2 diabetes mellitus(as per ADA criteria) were selected after obtaining consent.
Exclusion Criteria: Type 1 DM, pregnancy, CKD, CLD, Familial Dyslipidemias, hypothyroidism, hyperthyroidism, malignancies and Patients on Hypolipidemic drugs, beta blockers, thiazides, diuretics, corticosteroids. Lipid profile after 8 hours fasting and Lipid profile 2 hours after major meal was assessed. HDL-C was assessed by the direct assay method, and Friedewald's formula estimated LDL-C.
Observation: Out of 100 cases, the majority i.e. 46% were from 61-70 years, 38% from 51-60 years, 8% from 41-50 years and 4% each from 30-40 years and above 70 years. Mean age of the study population was 59.98±9.84 years. 51% were females and 49% were males. Prevalence of dyslipidemia in our study was: elevated TC-16%, elevated TG-63%, elevated LDL-17%, elevated VLDL-63% and reduced HDL-96%. Total cholesterol value was elevated in 16% diabetic patients in fasting status and also in post prandial status. Mean total cholesterol value of diabetic patients in fasting status was 170.78±37.90 and in post prandial status was 168.32±31.79. Difference was statistically insignificant. Triglyceride value was elevated in 63% diabetic patients in fasting status and in 68% of diabetic patients in post prandial status. Mean triglyceride value of diabetic patients in fasting status was 181.24±70.89 and in post prandial status was 184.12±70.24. Difference was statistically insignificant. There no statistically significant difference between LDL, HDL and VLDL in fasting and postprandial states.
Conclusion: There is very negligible difference in the mean values of fasting and postprandial lipid profile in our study. We would like to infer that Fasting lipid profile, which is usualy recomemded in view of consistency is neither covenient nor does it reflect the true biological state the person spends most of their time in.
(© Journal of the Association of Physicians of India 2011.)