Traditionally Insurers have requested fasting glucose and lipids but we think it’s time to forget fasting. Several studies have shown fasting is not necessary so why inconvenience your client?
Glucose
In 2011 the World Health Organisation concluded that HbA1c could be used to diagnose Diabetes Mellitus1.
The good news is that HbA1c does not require fasting and gives to an indication of blood glucose levels over a prolonged period. Some of the glucose in blood binds to haemoglobin in red blood cells (producing glycated haemoglobin or HbA1c). Red blood cells survive for about 2 to 3 months and as the amount of HbA1c depends on the concentration of glucose in the blood, it gives a good indication of the average blood glucose level over the past 2 to 3 months. Blood glucose, whether taken as a random or fasting sample, only gives an indication of the glucose concentration at that moment in time.
Lipids
Several studies have shown there appears to be little difference between fasting and non fasting lipid levels. As part of its updated guidance on ‘Cardiovascular disease: risk assessment and reduction, including lipid modification’, NICE indicated that a fasting sample is not needed and non-HDL cholesterol should be reported as part of the lipid profile2. In 2016 a joint consensus statement issued by the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine recommended that non-fasting blood samples are routinely used for the assessment of plasma lipid profiles3.
Is it too good to be true?
The HbA1c test costs more than a fasting glucose and there are certain medical conditions, notably haemoglobinopathies, that would make a HbA1c reading invalid. In clinical practice, the diagnosis of diabetes would not normally be made on the basis of a single test result.
If the non-fasting plasma triglyceride concentration is above 5 mmol/L, a fasting lipid profile should be considered3.
So, forget fasting and improve your customer’s journey.
Dr Anne King, BSc, MB ChB, MSc
CEO Square Health
References
- www.who.int/diabetes/publications/diagnosis_diabetes2011/en/
- www.nice.org.uk/guidance/cg181/chapter/implementation-getting-started
- doi.org/10.1093/eurheartj/ehw152
