Evaluation of Hemoglobin A1c Criteria to Assess Preoperative Diabetes Risk in Cardiac Surgery Patients

Abstract

In patients before cardiac surgery, A1C criteria identified the largest number of patients with diabetes and prediabetes. For diagnosing prediabetes, A1C and FPG were discordant and characterized different groups of patients, therefore altering the distribution of diabetes risk. Simultaneous measurement of FGP and A1C may be a more sensitive and specific tool for identifying high-risk individuals with diabetes and prediabetes.

Preoperative Glycosylated Haemoglobin Screening to Identify Older Adult Patients with Undiagnosed Diabetes Mellitus—A Retrospective Cohort Study

“…Several studies reported on the prevalence of undiagnosed DM in patients who planned to undergo surgery based on an HbA1c ≥ 48 mmol•mol −1 . The majority of these studies included patients undergoing a specific type of surgery [32][33][34][35][36][37][38][39][40][41], such as cardiac [32][33][34][35], orthopaedic [36,37] and bariatric surgery [38,39]. In a prospective study conducted in a university hospital in Canada, as much as 7% of patients aged 18 years or older undergoing elective non-cardiac surgery were found to have undiagnosed DM based on their preoperative HbA1c value [27].…”

“…Although the diagnosis of DM is based on either the plasma glucose or HbA1c criteria [12][13][14], the measurement of the HbA1c value is likely the most convenient option in the preoperative assessment clinic, as it does not require fasting and is not affected by factors such as timing, stress or diet. Nonetheless, it is important to note that there is considerable discordance in the diagnosis of DM when comparing the HbA1c and plasma glucose criteria, as these tests measure different aspects of glucose metabolism [33,42]. An HbA1c above the diagnostic threshold may only detect one-third of the cases of undiagnosed DM that would otherwise be identified based on FPG and OGTT testing [43].…”

Prevalence and Determinants of Glycemic Abnormalities in Cardiac Surgery Patients without a History of Diabetes: A Prospective Study

“…Sixty-one patients from the original cohort of 92 consecutive preoperative patients with no known diabetes, undergoing coronary artery bypass grafting (CABG), valve replacement, thoracic aortic procedures, or a combined procedure followed up for this study at a tertiary institution ( 6 ). Patients with known diabetes, organ transplantation, using glucocorticoids, or tube feedings were excluded.…”

“…Plasma glucose and A1C were measured as described ( 6 ). Insulin was measured by a double-antibody radioimmunoassay using 125 I-Human insulin tracer (Linco Research, Inc., St Charles, MO, USA).…”

When Anesthesiologists Should Stop Ordering a Tray of Blood Laboratory Tests Preoperatively in Cardiac and Non-cardiac Surgery?

“…Alongside with anesthesia, POE is mandatory in surgical management. Examples include preoperative education in ambulatory laparoscopic cholecystectomy [1], risk evaluation in patients over 75 years candidates to non-cardiac and cardiac surgery [2], and hemoglobin A1c to assess preoperative diabetes risk in cardiac surgery patients [3]. Anesthetic POE includes activity level assessment such as METS classification [4], drug history, past medical and surgical history, and sensitivity to drugs and foods.…”