Poor glycemic control is a strong predictor of postoperative morbidity and mortality in patients undergoing vascular surgery

Long, Chandler A.; Fang, Zachary B.; Hu, Frances Y.; Arya, Shipra; Brewster, Luke P.; Duggan, Elizabeth W.; Duwayri, Yazan

doi:10.1016/j.jvs.2018.06.212

Cited by 43 publications

(37 citation statements)

References 23 publications

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“…Furthermore, LEAD severity was not specified in more than a third of the enrolled patients. These might be possible reasons for the discrepancies between our results and those of Arya et al Recent studies in patients undergoing open vascular surgery demonstrated that poor glycemic control was associated with earlier postoperative outcomes such as in-hospital limb events [21] or 30-day mortality [22,23]. Compared with the results from studies in patients undergoing endovascular therapy, earlier effect of poor glycemic control on postoperative outcomes observed in patients undergoing vascular surgery may be attributed to surgery-related complications such as wound complications or postoperative infections.…”

Section: Role Of Glycemic Control On Vascular Outcomescontrasting

confidence: 86%

Influence of preprocedural glycemic control on clinical outcomes of endovascular therapy in diabetic patients with lower extremity artery disease: an analysis from a Korean multicenter retrospective registry cohort

Joon

Kim

et al. 2020

Cardiovasc Diabetol

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Background: The influence of intensive glucose control in diabetic patients on the macrovascular outcomes is controversial. Thus, this study aimed to elucidate the effect of preprocedural hemoglobin A1c (HbA1c) on clinical outcomes after endovascular therapy for lower extremity artery disease (LEAD) in diabetic patients.Methods: Diabetic patients were enrolled from the retrospective cohorts of a Korean multicenter endovascular therapy registry and were divided according to the HbA1c level during index admission into the optimal (< 7.0%) or suboptimal (≥ 7.0%) glycemic control groups. The primary endpoints were major adverse limb events (MALE, a composite of major amputation, minor amputation, and reintervention).Results: Of the 1103 patients enrolled (897 men, mean age 68.2 ± 8.9 years), 432 (39.2%) were classified into the optimal glycemic control group and 671 (60.8%) into the suboptimal glycemic control group. In-hospital events and immediate procedural complications were not different between the two groups. The suboptimal group showed a trend towards a higher incidence of MALE than the optimal group (log-rank p = 0.072). Although no significant differences were found between the two groups in terms of overall survival or amputation, the risk of reintervention was significantly higher in the suboptimal group (log-rank p = 0.048). In the multivariate Cox regression model, suboptimal glycemic control was one of the independent predictors for reintervention. When our data were analyzed according to the initial presentation, suboptimal preprocedural HbA1c significantly increased the incidence of MALE compared with optimal preprocedural HbA1c only in patients with intermittent claudication. Conclusion:In diabetic patients undergoing endovascular therapy for LEAD, suboptimal preprocedural HbA1c is associated with an increased risk of adverse limb events, especially in patients with intermittent claudication. Further

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Section: Role Of Glycemic Control On Vascular Outcomescontrasting

confidence: 86%

Influence of preprocedural glycemic control on clinical outcomes of endovascular therapy in diabetic patients with lower extremity artery disease: an analysis from a Korean multicenter retrospective registry cohort

Joon

Kim

et al. 2020

Cardiovasc Diabetol

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“…Recent observational studies have shown that both hyper‐ and hypoglycaemia are associated with complications after cardiac surgery . These reports indicate that it is important to maintain glucose levels in the normal range after cardiac surgery for improved prognosis.…”

Section: Discussionmentioning

confidence: 56%

“…This is the first report to demonstrate that the combination of a low-dose GLP-1 receptor agonist and insulin was effective in achieving glycaemic control without the risk of hypoglycaemia in the postoperative period in order to avoid postoperative complications. Recent observational studies have shown that both hyperand hypoglycaemia are associated with complications after cardiac surgery [10,11]. These reports indicate that it is important to maintain glucose levels in the normal range after cardiac surgery for improved prognosis.…”

Section: Discussionmentioning

confidence: 99%

Addition of low‐dose liraglutide to insulin therapy is useful for glycaemic control during the peri‐operative period: effect of glucagon‐like peptide‐1 receptor agonist therapy on glycaemic control in patients undergoing cardiac surgery (GLOLIA study)

Makino¹,

Tanaka²,

Asakura

et al. 2019

Diabet. Med.

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Aim To test the hypothesis that the addition of a glucagon‐like peptide‐1 receptor agonist that can decrease glucose levels without increasing the hypoglycaemia risk will achieve appropriate glycaemic control during the peri‐operative period. Methods We studied 70 people with Type 2 diabetes who underwent elective cardiac surgery. Participants were randomized to either an insulin‐alone or an insulin plus liraglutide 0.6 mg/day group. We evaluated average M values, which indicated the proximity index of the target glucose level from day 1 to day 10. Results The average M value in the liraglutide plus insulin group was significantly lower than that in the insulin‐alone group (liraglutide plus insulin 5.8 vs insulin‐alone 12.3; P < 0.001). The frequency of insulin dose modification in the liraglutide plus insulin group was significantly lower than that in the insulin‐alone group (odds ratio 0.19, 95% CI 0.08–0.49; P < 0.001). The frequency of hypoglycaemia in the liraglutide plus insulin group tended to be lower than that in the insulin‐alone group (odds ratio 0.57, 95% CI 0.15–2.23; P = 0.21). Conclusions The results of this study showed that the addition of low‐dose liraglutide to insulin achieved lower M values than insulin alone, suggesting that the addition of low‐dose liraglutide may achieve better glycaemic control during the peri‐operative period. (Clinical trials registry no.: UMIN 000008003)

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“…[ 13 , 23 ] Furthermore, obvious increasing trends were observed for abnormal HDL and FBG. Indeed, dyslipidemia and diabetes are well-known predictors for endothelial dysfunction and cardiovascular events, [ 24 , 25 ] and these observed trends may be related to changes in eating habits and lifestyle with socioeconomic development.…”

Section: Discussionmentioning

confidence: 99%

Impact of metabolic syndrome on short-term outcome of carotid revascularization: a large sample size study in Chinese population

Bai

Feng

Wang

et al. 2020

Chinese Medical Journal

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Background Metabolic syndrome (MetS) is relatively common worldwide and an important risk factor for cardiovascular diseases. It is closely linked to arterial stiffness of the carotid artery. However, the association of MetS with the safety of carotid revascularization has been rarely studied. The aim of this study was to observe the current status of MetS and its components in Chinese carotid revascularized patients, and investigate the impact on major adverse clinical events (MACEs) after carotid endarterectomy (CEA) or carotid artery stenting (CAS). Methods From January 2013 to December 2017, patients undergoing CEA or CAS in the Neurosurgery Department of Xuanwu Hospital were retrospectively recruited. The changes in prevalence of MetS and each component with time were investigated. The primary outcome was 30-day post-operative MACEs. Univariable and multivariable analyses were performed to identify the impact of MetS on CEA or CAS. Results A total of 2068 patients who underwent CEA (766 cases) or CAS (1302 cases) were included. The rate of MetS was 17.9%; the prevalence rate of MetS increased with time. The occurrence rate of MACEs in CEA was 3.4% (26 cases) and in CAS, 3.1% (40 cases). There was no statistical difference between the two groups (3.4% vs . 3.1%, P = 0.600). For CEA patients, univariate analysis showed that the MACE (+) group had increased diabetes history (53.8% vs . 30.9%, P = 0.014) and MetS (34.6% vs . 15.8%, P = 0.023). For CAS patients, univariate analysis showed that the MACE (+) group had increased coronary artery disease history (40.0% vs . 21.6%, P = 0.006) and internal carotid artery tortuosity (67.5%% vs . 37.6%, P < 0.001). Furthermore, the MACE (+) group had higher systolic blood pressure (143.38 ± 22.74 vs . 135.42 ± 17.17 mmHg, P = 0.004). Multivariable analysis showed that the influencing factors for MACEs in CEA included history of diabetes (odds ratio [OR] = 2.345; 95% confidence interval [CI] = 1.057–5.205; P = 0.036) and MetS (OR = 2.476; 95% CI = 1.065–5.757; P = 0.035). The influencing factors for MACEs in CAS included systolic blood pressure (OR = 1.023; 95% CI = 1.005–1.040; P = 0.010), coronary artery disease (OR = 2.382; 95% CI = 1.237–4.587; P = 0.009) and internal carotid artery tortuosity (OR = 3.221; 95% CI = 1.637–6.337; P = 0.001). Conclusions The prevalence rate of MetS increased with time in carotid revascularized patients. MetS is a risk for short-term MACEs after CEA, but not CAS. ...

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Poor glycemic control is a strong predictor of postoperative morbidity and mortality in patients undergoing vascular surgery

Cited by 43 publications

References 23 publications

Influence of preprocedural glycemic control on clinical outcomes of endovascular therapy in diabetic patients with lower extremity artery disease: an analysis from a Korean multicenter retrospective registry cohort

Influence of preprocedural glycemic control on clinical outcomes of endovascular therapy in diabetic patients with lower extremity artery disease: an analysis from a Korean multicenter retrospective registry cohort

Addition of low‐dose liraglutide to insulin therapy is useful for glycaemic control during the peri‐operative period: effect of glucagon‐like peptide‐1 receptor agonist therapy on glycaemic control in patients undergoing cardiac surgery (GLOLIA study)

Impact of metabolic syndrome on short-term outcome of carotid revascularization: a large sample size study in Chinese population

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