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Wednesday, January 26, 2022

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    Fasting no longer strictly required for glucose or cholesterol

    Dear Dr. Roach: My nurse practitioner just ordered blood tests, including blood sugar and cholesterol. He said I didn’t need to fast for either of them, but to inform the lab that I wasn’t fasting. This surprised me, since I’ve been fasting for years for these tests. I asked him if I could have coffee, breakfast, etc. No problem, he said. I asked him what was different, and he responded, “There’s new technology out there.” What is your opinion on his advice?

    — J.S.B.

    Dear J.S.B.: I’ll start with the blood sugar test, the main purpose of which is to identify abnormally high glucose, either as diabetes or its precursor, prediabetes, also called borderline diabetes or impaired glucose. Both a fasting glucose and a nonfasting glucose can give your clinician a clue, and an abnormal test would usually be followed up with a hemoglobin A1C or glucose tolerance test, which are definitive ways of diagnosing diabetes. A nonfasting glucose is at least as good of a screening test as a fasting glucose, since fasting glucose levels are normal until the condition is pretty advanced.

    Blood cholesterol is often measured as total cholesterol, HDL cholesterol, and triglycerides. A formula is used to estimate LDL cholesterol from these, as measuring LDL directly is expensive and time-consuming. Total and HDL cholesterol are not much affected by recent meals, but triglycerides are. Eating before a cholesterol panel usually makes the triglycerides go up, and makes the formula less accurate. Most clinicians still prefer a fasting cholesterol, although there are good data that using non-HDL cholesterol (that’s just the total cholesterol minus the HDL cholesterol) provides as much information about a person’s heart disease risk as a fasting, calculated LDL level.

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