Effect of the systemic inflammatory response, as provoked by elective orthopaedic surgery, on HbA<sub>1c</sub>

Chadburn, Andrew J.; Garman, Elizabeth; Abbas, R; Modupe, Anu; Ford, Clare; Thomas, Osmond; Chugh, Sanjiv; Deshpande, Shreeram; Gama, Rousseau

doi:10.1177/0004563216682536

Cited by 2 publications

(2 citation statements)

References 6 publications

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“…However, a prospective study of 30 patients undergoing elective orthopaedic surgery demonstrated no significant change in HbA1c despite a clear systemic inflammatory response 84. Therefore, we suggest that patients in whom an elevated HbA1c is found during an acute inflammatory episode undergo further screening for diabetes.…”

Section: Erythrocyte Turnovermentioning

confidence: 77%

HbA1c: a review of non-glycaemic variables

Campbell

Pepper

Shipman³

2018

J Clin Pathol

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Identification of the correlation between HbA1c and diabetic complications has yielded one of the most clinically useful biomarkers. HbA1c has revolutionised the diagnosis and monitoring of diabetes mellitus. However, with widespread adoption of HbA1c has come increasing recognition that non-glycaemic variables can also affect HbA1c, with varying clinical significance. Furthermore, the identification of a discrepancy between predicted and measured HbA1c in some individuals, the so-called ‘glycation gap’, may be clinically significant. We aimed to review the current body of evidence relating to non-glycaemic variables to quantify any significance and provide subsequent suggestions. A PubMed-based literature search was performed, using a variety of search terms, to retrieve articles detailing the non-glycaemic variables suggested to affect HbA1c. Articles were reviewed to assess the relevance of any findings in clinical practice and where possible guidance is given. A range of non-glycaemic variables have statistically significant effects on HbA1c. While the clinical implications are generally irrelevant, a small number of non-glycaemic variables do have clinically significant effects and alternative biomarkers should be considered instead of, or in addition to, HbA1c. There are a small number of non-glycaemic variables which have a clinically significant effect on HbA1c, However, the vast majority of non-glycaemic variables have no clinical relevance. While clinicians should have an awareness of those non-glycaemic variables with clinical significance, in the vast majority of clinical scenarios HbA1c should continue to be used with confidence.

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Section: Erythrocyte Turnovermentioning

confidence: 77%

HbA1c: a review of non-glycaemic variables

Campbell

Pepper

Shipman³

2018

J Clin Pathol

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“…1,2 Unlike HbA1c, the effects of nonglycemic variables on fructosamine are largely unknown. Acute illness has no effect on HbA1c, 3,4 but its effect on fructosamine has never been studied. We, therefore, investigated the effect of an acute phase response (APR), as provoked by elective orthopedic surgery, on fructosamine.…”

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confidence: 99%

Fructosamine: A Negative Acute Phase Reactant

Garman

Chadburn

Abbas

et al. 2017

J Diabetes Sci Technol

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Fructosamine is formed by the glycation of plasma proteins, mostly albumin but also immunoglobulins and other proteins. 1 In conditions where HbA1c measurement is unreliable, 1,2 fructosamine is a recommended alternative glycemic biomarker. 1,2 Unlike HbA1c, the effects of nonglycemic variables on fructosamine are largely unknown. Acute illness has no effect on HbA1c, 3,4 but its effect on fructosamine has never been studied. We, therefore, investigated the effect of an acute phase response (APR), as provoked by elective orthopedic surgery, on fructosamine.Twenty-nine nondiabetic patients (12 female; 70.1 [9.1] years) gave informed written consent to participate in this study approved by the National Research Ethics Service. Blood samples were collected before and 48 hours after surgery. Plasma glucose was measured and separated serum aliquoted and frozen until analyzed. CRP (immunoturbidimetry), albumin (bromocresol purple), total protein (biuret) and glucose (hexokinase/glucose-6-phosphate dehydrogenase) were measured using reagents supplied by Abbott diagnostics on the Abbott ARCHITECT c16000 analyzer (Abbott Diagnostics, Abbott Park, IL, USA). Fructosamine (nitrotetrazolium blue method) was measured on the ARCHITECT c16000 analyzer using Roche reagents (Roche Diagnostics, Mannheim, Germany GmbH). Globulin is the difference between total protein and albumin concentrations. Corrected fructosamine was calculated using the equation: Corrected fructosamine [µmol/L] = (Measured fructosamine [µmol/L] ÷ Total protein [g/L]) x 72. 5 CRP data were nonparametric but were normally distributed following logarithmic transformation. Other data were parametric. Student's t-test assessed the significance of preand postoperative differences in variables. Pearson's linear correlation assessed the significance of association between variables. Data (including pretransformed CRP data) are expressed as means with standard deviations in parentheses.Following surgery CRP and glucose increased, whereas fructosamine, albumin, and total protein decreased. Corrected fructosamine and globulin remained unchanged (Table 1).Logarithmic CRP correlated with fructosamine (r = -.3745, P = .0038), total protein (r = -.4279, P = .0008), albumin (r = -.7033, P < .0001) and glucose (r = .5665, P < .0001) but not with corrected fructosamine (r = .02638, P = .8441) or globulin (r = .02048, P = .8787).These data confirm an APR and are consistent with an APR-induced stress hyperglycemia. The data also confirm albumin and total protein to be negative acute phase reactants. Although not previously reported, our data indicate that fructosamine is also a negative acute phase reactant.

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Effect of the systemic inflammatory response, as provoked by elective orthopaedic surgery, on HbA_1c

Cited by 2 publications

References 6 publications

HbA1c: a review of non-glycaemic variables

HbA1c: a review of non-glycaemic variables

Fructosamine: A Negative Acute Phase Reactant

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Effect of the systemic inflammatory response, as provoked by elective orthopaedic surgery, on HbA1c

Cited by 2 publications

References 6 publications

HbA1c: a review of non-glycaemic variables

HbA1c: a review of non-glycaemic variables

Fructosamine: A Negative Acute Phase Reactant

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Effect of the systemic inflammatory response, as provoked by elective orthopaedic surgery, on HbA_1c