Fasting for lipid laboratory tests by patients with diabetes can lead to increased risk for what researchers are calling fasting-evoked en route hypoglycemia in diabetes, or FEEHD, according to findings published in the International Journal of Endocrinology.
Additionally, the study revealed a lack of widespread instruction about preventing FEEHD.
“A conceivably overlooked cause of hypoglycemia is the procurement of fasting labs, of which the lipid panel is the most commonly ordered fasting lab test,” Saleh Aldasouqi, MD, FACE, ECNU, professor of medicine and chief of the endocrinology division at Michigan State University College of Human Medicine, and colleagues wrote. “By ordering fasting labs, we may not only be inconveniencing patients, but we may also be inadvertently putting them at risk for hypoglycemia.”
Aldasouqi and colleagues analyzed data from 363 adults with diabetes (mean age, 60.6 years; 194 women; 81.6% with type 2 diabetes; mean diabetes duration, 16 years) enrolled in a nonrandomized, prospective study from March to September 2016. Each participant was asked to complete a questionnaire about diabetes type and duration, medication and FEEHD events in the previous 12 months.
Among the cohort, 17.1% (n = 62) of the respondents reported at least one episode of FEEHD in the previous year, 11% of whom reported multiple episodes. Participants who were deemed “at-risk” (n = 269) had a higher FEEHD occurrence rate than the overall study population (21.9%; n = 59). In the entire sample, 53% (n = 33) contacted a health care provider after a FEEHD episode. In addition, 35% (n = 22) had received education about how to prevent FEEHD. The researchers also found a significant correlation between FEEHD events and hypoglycemic symptoms (P < .001), frequency of any hypoglycemic events in the previous year (P < .001), insulin therapy (P = .014) and the use of an insulin pump (P < .001).
“In the United States, the tradition for fasting labs is deeply entrenched in the psyche of patients and physicians alike. In our clinical practice, it has been noticed that as soon as a patient is informed that labs may be required, one of their first responses is, ‘But, I am not fasting today,’” the researchers wrote. “Ordering fasting lipid profiles will not only put patients with diabetes at risk of hypoglycemia, but with the changing guidelines in lipid testing, fasting for lipid tests may not be necessary after all,” they wrote. – by Phil Neuffer
Disclosures: Aldasouqi reports he is a speaker for Alere and Janssen Pharmaceutical. Please see the study for all other authors’ relevant financial disclosures.