HbA1c Screening Characterizes Undiagnosed Dysglycemia in Surgical Patients

Abstract

Perioperative hyperglycemia is associated with increased morbidity and mortality. We analyzed the prevalence of undiagnosed dysglycemia, prediabetes (pre-DM) and diabetes (DM), in at-risk patients undergoing elective surgery at a large academic medical center. Methods: As part of a quality improvement project, patients reporting no history of diabetes, and meeting screening criteria (age > 45 years and/or BMI > 25 kg/m2), had an HbA1c measured during their Anesthesia Preoperative visit from 01/2015 to 12/2017. The Emory Clinical Data Warehouse was queried for demographics and blood glucose (BG) during hospitalization. Normoglycemia, pre-DM and DM were defined as HbA1c <5.7%, >5.7% to 6.5%, and >6.5%, respectively. Results: Among 7,430 patients denying history of DM, 4,204 (57%) met screening criteria. Prevalence of normoglycemia, pre-DM and DM was 69%, 27.2% and 3.9% respectively. Hospital BG was measured in 92% (n = 3,878); stress hyperglycemia (BG > 180 mg/dl) was observed in 6.4% of normoglycemia, 10.6% of pre-DM and 30.5% of DM patients (p <0.001). Conclusion: A universal pre-operative screening using HbA1C identified a high prevalence of undiagnosed pre-DM (27.2%) and DM (3.9%) in older and overweight adults. Dysglycemic patients were statistically more likely to experience stress hyperglycemia. Future research is needed to assess if intervention can reduce perioperative complications in this population.CharacteristicsNormoglycemiaPre-DiabetesDiabetesp-valueHbA1C, median5.3%5.9%6.7%Patients, n (%)2,892 (69%)1,148 (27.2%)164, (3.9%)Age, (years)57 ± 1461 ± 1261 ± 12P<0.01BMI, (kg/m2)29.0 ± 6.531.1 ± 7.733.6 ± 8.7P<0.01Female Gender, n (%)1,741 (60%)685 (60%)92 (56%)P = 0.53BG> 180 mg/dl, n (%)171 (6.4%)113 (10.6%)50 (30.5%)P < 0.001 Disclosure E.W. Duggan: None. V.N. O'Reilly-Shah: None. K.G. Tsegka: None. R.J. Galindo: None. G.E. Umpierrez: Research Support; Self; Sanofi US, Merck & Co., Inc., Novo Nordisk Inc., AstraZeneca. Advisory Panel; Self; Sanofi, Intarcia Therapeutics, Inc..

Capillary glycemia levels in diabetic patients undergoing elective surgery

“…Cuando se sospecha de mal control glicémico es imprescindible solicitar HbA1c para valoración en el preoperatorio inmediato. Los pacientes con cifras superiores a 7,5 % tienen más posibilidades de descompensación intra y postoperatoria (10,11) . Consideramos necesario conocer las características de los pacientes diabéticos sometidos a cirugías en nuestro hospital.…”