Study of knowledge, perception, and practice of patients regarding fasting requirements for blood glucose testing

Background: Patient preparation is one of the least standardized parts of the preanalytic phase of testing. Fasting blood glucose requires fasting for 8-12 hours as per various guidelines and also has several other requirements. Lack of communication, understanding, or compliance regarding hours-of-fasting, water-intake, avoidance of caloric snack/beverage, the sudden change in smoking, exercise, alcohol, medication, etc. introduces preanalytic errors. Method: To evaluate awareness, understanding, and compliance with fasting requirements, a face-to-face survey was done on outpatients in a Government Hospital in Pali, Rajasthan, India. Relatively more educated internet users were surveyed as controls through an online SurveyMonkey tool. Information collected included demographics, perception of above mentioned preanalytic factors related to fasting, and compliance. Results: 98 patients and 187 controls participated in the study. Perception about fasting requirements ranged from 0-17 hours. 71% of patients and 35% of controls perceived that nobody explained to them the duration or nature of fasting. The different sources of information had been used in different proportions by patients and controls. For imparting understanding and compliance about duration, and other requirements of fasting, the instruction was usually incomplete but still much more effective (p-value=0.000002) than formal education level (p-value=0.024). Financial status had a weak negative association with awareness but was not significant. Conclusion: 71% of patients and 35% of controls did not receive instructions for fasting. 40% of those instructed showed better compliance, but awareness was incomplete. The instruction was more effective than formal education in improving awareness and compliance. Improved awareness was strongly associated with receiving instruction and weakly associated with formal education but financial status showed only a weak negative association

Serum triacylglycerol: A putative early biomarker of disease severity of Type 2 diabetes mellitus compared to microalbuminuria

499-504Poorly controlled type 2 diabetes mellitus progresses to several complications including nephropathy. While glycated hemoglobin demarcates severity, urinary microalbumin indicates renal involvement. Considering nephropathy is a late manifestation of the disease, here, we explored whether serum triacylglycerol (TAG) can be used as an early disease severity biomarker. About 100 Type 2 diabetes mellitus patients were recruited and categorized as moderate (n=43) and severe (n=57) based on glycated haemoglobin (8%) level. Duration of the disease, BMI, systolic and diastolic BP, fasting and Post Prandial plasma glucose, glycated haemoglobin, serum lipid profile and urinary microalbumin were measured. Results obtained were compared between the groups and correlated. Taking glycated haemoglobin as reference, receiver operating characteristic curves were constructed for serum triacylglycerol and urinary microalbumin excretion to check their efficacy as classifier of disease severity. Significant differences (P <0.001) were recorded for plasma glucose, glycated haemoglobin, triacylglycerol and microalbuminuria but not for other parameters. Significant association (P <0.001) of glycated haemoglobin was displayed with triacylglycerol (r=0.67), fasting (r=0.0.71) and Post Prandial (r=0.82) plasma glucose and urine microalbumin levels (r=0.54). Serum triacylglycerol and urinary microalbumin levels also showed significant correlation (P <0.001, r=0.44). ROC curve analysis showed better performance of triacylglycerol (AUC=0.97) than microalbuminuria (AUC=0.88) to demarcate severity of diabetes. The results indicate that serum triacylglycerol is a better classifier of Type 2 diabetes mellitus than urinary microalbumin level, and may help in early assessment of the disease progression