Glycemic Control before Surgery Important

Better outcomes for diligent glucose
controllers; © Hemera

Annika S. Dronge, M.D. from Yale University School of Medicine and colleagues examined the relationship between glycaemic control and postoperative infections in 490 diabetic patients. All of the participants underwent major noncardiac surgery between January 1, 2000, and September 30, 2003, and had their haemoglobin (Hb A1c) levels measured within 180 days prior to surgery. Hb A1c reflects the patient's control of blood glucose levels over the previous two to three months. Good glycaemic control was defined as an Hb A1c level of less than seven percent.

The patients had an average age of 71 years and 40 percent had good glycaemic control. Those who did not have good glycaemic control had higher rates of infectious complications after surgery, as did those who were older, had higher scores on physical status tests, had wounds that were classified as "nonclean" or had operations that took longer.

There could be two reasons for the association between glycaemic control and infections, according to the authors. One is that patients with better preoperative glycaemic control are likely to have lower blood sugar levels after surgery as well, which has been shown in other studies to reduce risk of infection. "The other possibility for decreased postoperative infection with long-term glucose control is the overall improvement in general health and metabolic milieu of the well-controlled diabetic patient," the authors write.

"In conclusion, this study confirmed an association between tight preoperative glucose control, as indicated by Hb A1c levels less than 7 percent, and a decreased risk of postoperative infections across a spectrum of surgical cases," they conclude. "If the association is confirmed in other studies, strategies to improve glycaemic control prior to elective surgery can be employed."

MEDICA.de; Source: JAMA and Archives Journals