LKPAC Posted June 21, 2018 Share Posted June 21, 2018 There is a movement in our office lately to disregard fasting for routine labs including CMP and lipids. Too often, patients show up not fasting. Lipids are not affected. If glucose is too high, we can confirm with HgbA1C or repeat labs. Anyone else doing this? Link to comment Share on other sites More sharing options...
camoman1234 Posted June 21, 2018 Share Posted June 21, 2018 56 minutes ago, LKPAC said: There is a movement in our office lately to disregard fasting for routine labs including CMP and lipids. Too often, patients show up not fasting. Lipids are not affected. If glucose is too high, we can confirm with HgbA1C or repeat labs. Anyone else doing this? Yes, lipid are not affected, but TRGs are. There is several research articles out there stating the same, and I can tell you that it is true as I did fasting vs non fasting BW on myself just a few weeks ago. TC, HDL, LDL were withing a few points, TRGs were up about 50 points. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted June 21, 2018 Share Posted June 21, 2018 I don't like nonfasting lipids - I actually had a guy do nonfasting one day with LDL 160 and Trig 300 and repeated fasting 3 days later with marked reduction in both. LDL now below 130. So, I really have no use for non-fasting labs - my opinion. I have seen the issue and don't think it is worth it to "hope" that a nonfasting is ok. If all the years past - the labs are fasting and we have graphs and grids comparing - should just stay fasting. One day of not eating for 10-12 hours is not going to hurt anyone. We allow our patients to do labs up to a week before their appt or same day. We have a cafeteria - they can go eat after labs and before their appt. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted June 21, 2018 Moderator Share Posted June 21, 2018 The literature has determined definitively that fasting vs non-fasting has not altered treatment for lipids. I haven’t been doing fasting lipid panels for 3 years now. It does affect TG, but you aren’t worried about those until over 500 for risk of pancreatitis and treating them has not shown a difference in cardiovascular outcomes. Link to comment Share on other sites More sharing options...
cbrsmurf Posted June 21, 2018 Share Posted June 21, 2018 Agreed. There is pretty strong evidence that fasting does not affect lipids and as well as most labs. The variance you see in lipids is likely due to assay/laboratory variability. Honestly lipids are something you should measure only once every 2-5 years and only if they are intermediate risk or higher. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted June 21, 2018 Moderator Share Posted June 21, 2018 6 minutes ago, cbrsmurf said: Agreed. There is pretty strong evidence that fasting does not affect lipids and as well as most labs. The variance you see in lipids is likely due to assay/laboratory variability. Honestly lipids are something you should measure only once every 2-5 years and only if they are intermediate risk or higher. Another good point. I only started doing that in my last year in FM, that is not testing everyone of a certain age every year, rather risk stratifying them. Link to comment Share on other sites More sharing options...
camoman1234 Posted June 21, 2018 Share Posted June 21, 2018 1 hour ago, LT_Oneal_PAC said: Another good point. I only started doing that in my last year in FM, that is not testing everyone of a certain age every year, rather risk stratifying them. Agree, but don't....you have more solid/objective evidence you show them then statistics.... I like my farmers to not eat just fried frog legs and catfish...I have helped a lot of people out around here with their diet by showing then proof NOT just risk stratifying numbers.... Link to comment Share on other sites More sharing options...
thinkertdm Posted June 22, 2018 Share Posted June 22, 2018 So...with fasting labs, we can look at a near normal trig and ldl then they are making a beeline to Hardy's or Waffle house after the appointment, with the knowledge their cholesterol is "ok". Why not check them non fasting, and if abnormal, do something crazy, like recheck them? Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted June 22, 2018 Share Posted June 22, 2018 How about we save them the recheck costs and if treatment is for primary CV prevention then treat them per guidelines? Unless familial hypertriglyceridemia you’re primarily watching for pancreatitis concerns OR what metabolic condition (very common) may present with hypertriglyceridemia? Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted June 22, 2018 Administrator Share Posted June 22, 2018 For blood glucose, I never check that in isolation--ever since I started in practice in 2012, I went with A1c: no muss, no fuss, no recheck for 90 days. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.