An Elevated HbA1c Level Is Associated With Short-Term Adverse Outcomes in Patients With Gastrointestinal Cancer and Type 2 Diabetes Mellitus

Abstract

BackgroundAlthough an elevated hemoglobin A1c (HbAc1) level is an independent predictor of worse survival in patients with both digestive cancer and diabetes mellitus, its relationship to short-term prognosis in these patients has not been addressed. This study assessed this relationship in gastrointestinal cancer (GIC) patients with type 2 diabetes mellitus (T2DM).MethodsA retrospective review of patients with GIC with or without T2DM from 2004 to 2014 was performed. Patients with T2DM were grouped according to HbA1c level, either normal (mean < 7.0%) or elevated (mean ≥ 7.0%). Age- and sex-matched GIC patients without T2DM served as controls.ResultsOne hundred and eighteen patients aged 33 - 81 years with T2DM met the study eligibility criteria; 51 were in the normal HbA1c group, and 67 were in the elevated HbA1c group. The 91 patients in the non-T2DM group were randomly selected and matched to the T2DM group in terms of admittance date, age, and sex. There was a trend toward a higher 180-day mortality rate in the T2DM group compared with the non-T2DM group (15.3% vs. 7.7%, P = 0.095) and in the elevated HbA1c group compared with the normal HbA1c group (19.4% vs. 9.8%, P = 0.151); however, the differences were not significant. The duration of the hospital stay was longer in patients with T2DM than in those without T2DM (13.2 vs. 8.9 days, P < 0.05) and in patients with elevated versus normal HbA1c levels (14.5 vs. 11.4 days, P < 0.05). Diabetic GIC patients with elevated HbA1c levels had significantly more total postoperative complications than those with normal HbA1c levels (25.4% vs. 9.8%, P < 0.05). In multivariate regression analyses, short-term adverse outcomes were strongly associated with elevated HbA1c levels (odds ratio (OR): 5.276; 95% confidence level (CI): 1.73 - 16.095; P < 0.05) and no strict antidiabetic treatment (OR: 7.65; 95% CI: 2.49 - 23.54; P < 0.001).ConclusionAn elevated level of HbA1c significantly correlated with and was an independent predictor of short-term adverse outcomes in GIC patients with T2DM.

<p>Self-Care Adherence And Barriers To Good Glycaemic Control In Nepalese Type 2 Diabetes Mellitus Patients: A Hospital-Based Cross-Sectional Study</p>

“…A significantly higher level of TC and TG was found among the poor glycemic control group compared to the good glycaemic control group as similarity with other findings 46. The deregulation of lipid metabolism among diabetes is supposedly due to affected action of insulin in the key enzymes; further influx of fatty acids from adipose tissue may result in progressive insulin resistance and β-cell dysfunction worsening the condition 47…”

The impact of preoperative glycated hemoglobin (HbA1c) on postoperative complications after elective major abdominal surgery: a meta-analysis

“…The postoperative complications extracted from the primary studies were initially graded according to CD classification, and then grouped for intent of either the primary outcome (major postoperative complications) or secondary outcome (overall postoperative complications) analyses. Examples of postoperative complications from the primary studies that fulfilled the definition of our primary outcome of 'Major Postoperative Complications' include "reoperation" [17], "anastomotic leak" [18]- [23], "30-day mortality" [23] and "major complications fulfilling CD3-5" [24]- [26]. Secondary outcomes were categorised into overall complications, anastomotic leak, postoperative ileus, overall infections, wound infection, pneumonia, sepsis, cardiopulmonary complications, and renal failure [13],…”

“…The HbA1c cut-off used to dichotomise case and control groups were variable. The most common cut-off points were HbA1c 6.5% [19], [24], [26], [31], [32] and 7.0% [17], [20], [23], [34] with five and four studies respectively. Most studies used a HbA1c measurement within at least 3 months before surgery, except for one study which used HbA1c…”

“…measurements within 6 months before surgery [35]. A few studies did not state the timeframe window between HbA1c measurement and surgery [17], [20]- [23], [32], [34]. A total of 25036 patients were included in the quantitative analysis.…”

“…The most studied outcome measures were infection [17], [18], [20], [22], [23], [31], [34] and anastomotic leak [18]- [23], [34]. Some studies investigated the individual effects of different types of infection such as pneumonia, urinary tract infection (UTI), wound infection, and sepsis [17], [18], [23], [31],…”