Glycaemic dysregulation in nondiabetic patients after major lower limb prosthetic surgery

Pili-Floury, Sébastien; Mitifiot, F.; Penfornis, A.; Boichut, N.; Tripart, M.-H.; Jamin, Christophe; Garbuio, P.; Samain, Emmanuel

doi:10.1016/j.diabet.2008.06.007

Cited by 18 publications

(15 citation statements)

References 21 publications

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“…This raises the question of whether patients in the NGT group have a transient stress-induced disturbance in glycemic tolerance due to acute myocardial infarction. A similar pattern of stress-induced post-meal glycemic changes has been reported after prosthetic surgery [27]. Acute stressinduced hyperglycemia is also supported by a study where 61% of non-diabetic patients with acute stroke had AGT at discharge, but after re-investigation at three months more than half of them were categorized as having NGT [28].…”

Section: Discussionsupporting

confidence: 60%

Postmeal Glucose Compared to Oral Glucose Tolerance in Non-Diabetic Patients with Acute Myocardial Infarction

Arola¹,

Nevalainen²,

Kotila³

et al. 2014

TODIAJ

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Abstract:Background: Abnormal glucose tolerance (AGT) in non-diabetic patients with acute myocardial infarction is associated with decreased survival compared to those with normal glucose tolerance (NGT). The aim of this study was to test if two-hour postprandial glucose (PPG2h) after a mixed meal correlates with the two-hour oral glucose tolerance test (OGTT2h). Methods:We prospectively enrolled 189 non-diabetic patients with acute myocardial infarction.Results: According to the oral glucose tolerance test (OGTT), 37.0% had NGT, 4.8% had impaired fasting glucose, 37.6% had impaired glucose tolerance (IGT) and 20.6% had diabetes. PPG2h after each meal correlated with OGTT2h (R 2 = 0.13-0.26, P<0.001). In diabetic patients, PPG2h levels after each meal were higher (p<0.01 for all) than in the IGT and NGT group. In the NGT and IGT group, PPG2h was higher after lunch and dinner than after breakfast (p<0.01), but this was not the case in the diabetic patients. In detecting diabetes compared to OGTT2h, PPG2h equal to or above 5.6 mmol/l after breakfast, 6.5 mmol/l after lunch and 7.0 mmol/l after dinner had a sensitivity of at least 76% and specificity of at least 42%. Glucose values below the cut-off values suggest that OGTT need not be evaluated. Conclusion:PPG2h is a quick, practical, simple and easy measurement in clinical practice. PPG2h correlates with OGTT but the value is lower, so PPG2h cannot be used to evaluate postprandial glycemia with the current OGTT glycemic thresholds. We therefore suggest the use of new cut-off values for PPG2h after a random meal to select patients in whom OGTT is not needed to evaluate diabetic status.

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Section: Discussionsupporting

confidence: 60%

Postmeal Glucose Compared to Oral Glucose Tolerance in Non-Diabetic Patients with Acute Myocardial Infarction

Arola¹,

Nevalainen²,

Kotila³

et al. 2014

TODIAJ

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“…We controlled for multiple factors, including age, sex, diabetes, surgical type, physical status, emergency procedure, duration of operation and blood transfusion units that collectively confounded the association between glucose levels and SSIs. It is possible that elevations in post-operative glucose levels among those who developed SSI may reflect the natural glycemic dysregulation that occurs with surgery, the extent to which could be correlated with specific procedures that increase the risk of infections [28].…”

Section: Discussionmentioning

confidence: 99%

The Role of Pre-Operative and Post-Operative Glucose Control in Surgical-Site Infections and Mortality

et al. 2012

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Background and ObjectiveThe impact of glucose control on surgical-site infection (SSI) and death remains unclear. We examined how pre- and post-operative glucose levels and their variability are associated with the risk of SSI or in-hospital death.MethodsThis retrospective cohort study employed data on 13,800 hospitalized patients who underwent a surgical procedure at a large referral hospital in New York between 2006 and 2008. Over 20 different sources of electronic data were used to analyze how thirty-day risk of SSI and in-hospital death varies by glucose levels and variability. Maximum pre- and post-operative glucose levels were determined for 72 hours before and after the operation and glucose variability was defined as the coefficient of variation of the glucose measurements. We employed logistic regression to model the risk of SSI or death against glucose variables and the following potential confounders: age, sex, body mass index, duration of operation, diabetes status, procedure classification, physical status, emergency status, and blood transfusion.ResultsWhile association of pre- and post-operative hyperglycemia with SSI were apparent in the crude analysis, multivariate results showed that SSI risk did not vary significantly with glucose levels. On the other hand, in-hospital deaths were associated with pre-operative hypoglycemia (OR = 5.09, 95% CI (1.80, 14.4)) and glucose variability (OR = 1.14, 95% CI (1.03, 1.27) for 10% increase in coefficient of variation).ConclusionIn-hospital deaths occurred more often among those with pre-operative hypoglycemia and higher glucose variability. These findings warrant further investigation to determine whether stabilization of glucose and prevention of hypoglycemia could reduce post-operative deaths.

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“…In thoracic surgery, postoperative hyperglycemia increases the risk of mediastinitis, and conversely, strict glycemic control postoperatively has resulted in lower infection rates (Furnary and Wu 2006). Although perioperative hyperglycemia occurs in up to three quarters of non-diabetic patients undergoing knee or hip replacement (Pili-Floury et al 2009), there have been no studies evaluating the association between perioperative hyperglycemia and postoperative infection rate in the field of joint replacement surgery.…”

Section: Perioperative Managementmentioning

confidence: 99%

Prevention of deep infection in joint replacement surgery

et al. 2010

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Glycaemic dysregulation in nondiabetic patients after major lower limb prosthetic surgery

Cited by 18 publications

References 21 publications

Postmeal Glucose Compared to Oral Glucose Tolerance in Non-Diabetic Patients with Acute Myocardial Infarction

Postmeal Glucose Compared to Oral Glucose Tolerance in Non-Diabetic Patients with Acute Myocardial Infarction

The Role of Pre-Operative and Post-Operative Glucose Control in Surgical-Site Infections and Mortality

Prevention of deep infection in joint replacement surgery

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