The prevalence of undiagnosed diabetes in non-cardiac surgery patients, an observational study

Abstract

Purpose Given that preoperative hyperglycemia is associated with poor outcomes and many non-diabetic patients have high plasma glucose (PG) levels, the purpose of our study was to estimate the prevalence of undiagnosed diabetes among non-cardiac surgery patients and to identify predictors of hyperglycemia in non-diabetics. MethodsWe included all non-cardiac surgery patients with complete records in the Clinical Database of the Anesthesiology Institute at the Cleveland Clinic during January 2007 to April 2009, and we estimated the prevalence of undiagnosed diabetes and impaired fasting glucose (IFG) among the non-diabetic patients. The mean glucose levels for known diabetics and undiagnosed diabetics were compared using two-tailed Student's t tests, and we assessed the association between PG levels and demographic variables within the non-diabetics. Results Of the 39,434 patients analyzed, 5,511 (14%) were known diabetics. Of the 33,923 known non-diabetics, 3,426 (10 %) were undiagnosed diabetics and another 3,549 (11%) had IFG. Thus, 6,975 patients (21%) of the non-diabetic patients presented with abnormally high glucose. Previously undiagnosed diabetics had higher preoperative glucose levels compared with known diabetics, with a mean ± standard deviation (SD) of 161 ± 48 vs 146 ± 67 mgÁdL -1 (8.9 ± 2.7 vs 8.1 ± 3.7 mmoLÁL -1 ), respectively. The difference remained highly significant after adjusting for body mass index, age, sex, and American Society of Anesthesiologists (ASA) physical status (P \ 0.001). Among non-diabetics, older age, obesity, male sex, and a higher ASA physical status were collectively significant predictors of hyperglycemia, with a c-statistic (95% confidence interval) of 0.67 (0.66-0.68). Conclusion A significant proportion of non-cardiac surgery patients have previously undiagnosed diabetes and pre-diabetes. Previously undiagnosed patients have higher fasting glucose levels compared with diabetic patients. Further studies should be conducted to identify the implications of these findings on patient outcomes. RésuméObjectif E´tant donne´que l'hyperglyce´mie pre´ope´ratoire est associe´e à un mauvais pronostic et que de nombreux Preliminary results were presented at

Preoperative blood glucose concentrations and postoperative outcomes after elective non-cardiac surgery: an observational study

“…13 14 In an earlier study, we showed that 21% of noncardiac surgery patients without a diagnosis of diabetes are hyperglycaemic and more than half of those have undiagnosed diabetes. 15 Similar findings have been also reported by Hatzakorzian and colleagues. 16 While previously fasting glucose concentrations were used to diagnose diabetes, 14 more recently, HbA1c has been advocated to be used as a screening test to diagnose diabetes.…”

Perioperative catabolism

“…In a prospective study in 500 patients presenting for elective procedures, 26% of previously undiagnosed patients showed blood glucose levels in the impaired-fasting glucose or diabetic range. 9,10 Protein catabolism Typical features of protein catabolism are stimulated rates of protein breakdown and amino acid oxidation which lead to a net loss of body protein. [11][12][13] Metabolically healthy patients lose 40-80 g of nitrogen after elective abdominal surgery, equivalent to 1.2-2.4 kg of wet skeletal muscle.…”

Predictors of hyperglycemia after cardiac surgery in nondiabetic patients

“…Although we took all possible precautions to exclude diabetic patients in this study, some of the patients may still have undiagnosed diabetes because of the high prevalence of diabetes in patients undergoing cardiac surgery. 21 A review of our database revealed that 829 patients (22.6%) had an HbA1c measured within 3 months preoperatively. We excluded patients with an HbA1c greater than 6.5%.…”