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Effect of A1C & Glucose on Postoperative Mortality
Diabetes Care; ePub 2018 Feb 13; van den Boom, et al
Hemoglobin A1c (A1C) is positively associated with perioperative glucose, but is not associated with increased 30-day mortality after controlling for glucose, a recent study found. The retrospective analysis on 431,480 surgeries determined the association of preoperative A1C with perioperative glucose and 30-day mortality among 6,684 noncardiac surgeries with A1C and glucose measurements. Researchers found:
- A1C and glucose were strongly associated.
- Glucose and mortality were positively associated for noncardiac cases: 1.0% mortality at mean glucose of 100 mg/dL and 1.6% at mean glucose of 200 mg/dL.
- For cardiac procedures, there was a U-shaped relationship between glucose and mortality ranging from 4.5% at 100 mg/dL, to a base of 1.5% at 140 mg/dL, and rising again to 6.9% at 200 mg/dL.
- A1C and 30-day mortality were not associated when controlling for glucose in noncardiac or cardiac procedures.
Citation:
van den Boom W, Schroeder RA, Manning MW, et al. Effect of A1C and glucose on postoperative mortality in noncardiac and cardiac surgeries. [Published online ahead of print February 13, 2018]. Diabetes Care. doi:10.2337/dc17-2232.
It is clear that hyperglycemia in the perioperative period is associated with adverse outcomes, including poor wound healing, increased rate of infection, and even increased mortality. While studies have shown a relationship between both elevated A1c, or perioperative glucose and surgical outcomes, little has been done in the way of separating out the effect of these 2 variables. This study shows that control of perioperative blood glucose is the primary factor, with either too tight control or control that is not tight enough leading to worse outcomes. Consistent with the current recommendations for in-hospital management, this study supports glucose targets of 140 mg/dl to 180 mg/dl.1 —Neil Skolnik, MD