A Study to Establish the Validity of Non-Fasting Lipid Profile against Fasting Lipid Profile for Making Treatment Decision in Diabetes Mellitus 2012-2014

Abstract

As incidence of diabetes is continuously increasing in india and diabetic dyslipidemia is a leading cause of atherosclerotic disease process like coronary artery disease. If we diagnosed and treat dyslipidemia in early stage, we can decrese the risk of atherosclerotic diseases. But current guidelines recommend measurement of fasting lipid profile and majority of the patients present in the hospital are in nonfasting state so their lipid profile is deferred due to their nonfasting status which impedes their treatment. However, recent studies suggest nonfasting lipid profile may better or similarly predict cardiovascular disease events than fasting levels. So, if validate for treatment of diabetic dyslipidemia then measurement of nonfasting lipid profile may have many practical advantage for clinical practice. So a prospective study was carried out in 100 diabetic patients in 25-65 years age group including both sexes irrespective of community or background which were present in inpatient department of medicine, Mata Chanan Devi hospital, New Delhi, during the time period of 2012-2014. It is a 210 bedded, tertiary care hospital in west Delhi, where the patients travel from all north India. The patients with Coronary event (myocardial infarction, unstable angina) and procedures (coronary artery bypass, coronary angioplasty) in previous 4 weeks, ischemic stroke in prior 3 months, chronic alcoholic patients, patients having pancreatitis, hypothyroidism, pregnancy and patients on lipid lowering drugs in previous 3 months, were not included in the study. After taking written informed consent lipid profile was done from each subject at the time of admission and next day morning (after 8-12 hr fasting). Self reported time since last meal was also noted at the time of admission. LDL was measured by direct method. Non HDL cholesterol was calculated by total cholesterol – HDL cholesterol. SPSS (statistical package for social sciences) software version 16.0 was used for statistical analysis. Wilcoxon Signed Ranks test done to compare the total mean fasting and nonfasting lipid profile. We divided the study subjects according to self reported time since last meal. Like 0-1 hour include patient taking meal before < 1 hour and 1-2 hour include <2 hour post meal and so on other groups. Comparison of fasting and non fasting lipid profile was done by Wilcoxon