Chronic glycemic control influences the relationship between acute perioperative dysglycemia and perioperative outcome

IF 3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Pub Date : 2024-10-22 DOI:10.1111/1753-0407.70015

Brandon Stretton, Andrew E. C. Booth, Joshua Kovoor, Aashray Gupta, Ammar Zaka, Suzanne Edwards, S. George Barreto, Guy Maddern, Stephen Bacchi, Mark Boyd

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Abstract

Background

The objective of this study was to evaluate the impact of dysglycemia on perioperative outcomes, in patients with and without diabetes, and how prior glycemic control modifies these relationships.

Methods

Consecutive surgical patients admitted to six South Australian tertiary hospitals between 2017 and 2023 were included. Blood glucose levels within 48 h pre- and post-operatively were assessed in an adjusted analyses against a priori selected covariates. Dysglycemia metrics were hyperglycemia (>10.0 mmol/L), hypoglycemia (<4.0 mmol/L), glycemic variability (standard deviation of mean blood glucose >1.7 mmol/L), and stress hyperglycemic ratio (SHR). The primary outcome was hospital mortality.

Results

Of 52 145 patients, 7490 (14.4%) had recognized diabetes. Inpatient mortality was observed in 787 patients (1.5%), of which 150 (19.1%) had diabetes mellitus. Hyperglycemia was associated with increased mortality in patients with diabetes (odds ratio [OR] = 2.99, 95% CI: 1.63–5.67, p = 0.004) but not in non-diabetics, who instead had an increased odds of intensive care unit (ICU) admission if hyperglycemic (OR = 1.95, 95% CI: 1.40–2.72, p < 0.0001). Glycemic variability was associated with increased mortality in patients with diabetes (OR = 1.46, 95% CI: 1.05–2.01, p < 0.05) but not in non-diabetics. Preoperative glycemic control (HbA1c) attenuated both of these associations in a dose-dependent fashion. Hypoglycemia was associated with increased mortality in non-diabetics (OR = 2.14, 95% CI: 1.92–2.37, p < 0.001) but not in patients with diabetes.

Conclusions,

In surgical patients with diabetes, prior exposure to hyperglycemia attenuates the impact of perioperative hyperglycemia and glycemic variability on inpatient mortality and ICU admission. In patients without diabetes mellitus, all absolute thresholds of dysglycemia are associated with ICU admission, unlike those with diabetes, suggesting the need to use more relative measures such as the SHR.

Abstract Image

查看原文本刊更多论文

慢性血糖控制会影响急性围手术期血糖异常与围手术期结果之间的关系。

背景：本研究旨在评估血糖异常对糖尿病患者和非糖尿病患者围手术期结果的影响，以及之前的血糖控制如何改变这些关系：本研究旨在评估糖尿病患者和非糖尿病患者血糖异常对围手术期结果的影响，以及之前的血糖控制如何改变这些关系：纳入2017年至2023年期间入住南澳大利亚州六家三级医院的连续手术患者。根据事先选定的协变量进行调整分析，评估术前和术后 48 小时内的血糖水平。血糖异常指标包括高血糖（>10.0 mmol/L）、低血糖（1.7 mmol/L）和应激性高血糖比率（SHR）。主要结果是住院死亡率：在 52 145 名患者中，有 7490 人（14.4%）被确认患有糖尿病。住院患者死亡率为 787 人（1.5%），其中 150 人（19.1%）患有糖尿病。高血糖与糖尿病患者的死亡率增加有关（比值比 [OR] = 2.99，95% CI：1.63-5.67，p = 0.004），但与非糖尿病患者无关。95，95% CI：1.40-2.72，p 结论：在糖尿病手术患者中，事先暴露于高血糖可减轻围术期高血糖和血糖变化对住院死亡率和入住 ICU 的影响。在没有糖尿病的患者中，与糖尿病患者不同的是，血糖异常的所有绝对阈值都与入住 ICU 有关，这表明需要使用 SHR 等更相对的测量方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

2.20%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Diabetes (JDB) devotes itself to diabetes research, therapeutics, and education. It aims to involve researchers and practitioners in a dialogue between East and West via all aspects of epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes, including the molecular, biochemical, and physiological aspects of diabetes. The Editorial team is international with a unique mix of Asian and Western participation. The Editors welcome submissions in form of original research articles, images, novel case reports and correspondence, and will solicit reviews, point-counterpoint, commentaries, editorials, news highlights, and educational content.