Perioperative hyperglycemia is associated with increased morbidity and mortality. We analyzed the prevalence of undiagnosed dysglycemia, prediabetes (pre-DM) and diabetes (DM), in at-risk patients undergoing elective surgery at a large academic medical center.
Methods: As part of a quality improvement project, patients reporting no history of diabetes, and meeting screening criteria (age > 45 years and/or BMI > 25 kg/m2), had an HbA1c measured during their Anesthesia Preoperative visit from 01/2015 to 12/2017. The Emory Clinical Data Warehouse was queried for demographics and blood glucose (BG) during hospitalization. Normoglycemia, pre-DM and DM were defined as HbA1c <5.7%, >5.7% to 6.5%, and >6.5%, respectively.
Results: Among 7,430 patients denying history of DM, 4,204 (57%) met screening criteria. Prevalence of normoglycemia, pre-DM and DM was 69%, 27.2% and 3.9% respectively. Hospital BG was measured in 92% (n = 3,878); stress hyperglycemia (BG > 180 mg/dl) was observed in 6.4% of normoglycemia, 10.6% of pre-DM and 30.5% of DM patients (p <0.001).
Conclusion: A universal pre-operative screening using HbA1C identified a high prevalence of undiagnosed pre-DM (27.2%) and DM (3.9%) in older and overweight adults. Dysglycemic patients were statistically more likely to experience stress hyperglycemia. Future research is needed to assess if intervention can reduce perioperative complications in this population.
| Characteristics | Normoglycemia | Pre-Diabetes | Diabetes | p-value |
| HbA1C, median | 5.3% | 5.9% | 6.7% | |
| Patients, n (%) | 2,892 (69%) | 1,148 (27.2%) | 164, (3.9%) | |
| Age, (years) | 57 ± 14 | 61 ± 12 | 61 ± 12 | P<0.01 |
| BMI, (kg/m2) | 29.0 ± 6.5 | 31.1 ± 7.7 | 33.6 ± 8.7 | P<0.01 |
| Female Gender, n (%) | 1,741 (60%) | 685 (60%) | 92 (56%) | P = 0.53 |
| BG> 180 mg/dl, n (%) | 171 (6.4%) | 113 (10.6%) | 50 (30.5%) | P < 0.001 |
| Characteristics | Normoglycemia | Pre-Diabetes | Diabetes | p-value |
| HbA1C, median | 5.3% | 5.9% | 6.7% | |
| Patients, n (%) | 2,892 (69%) | 1,148 (27.2%) | 164, (3.9%) | |
| Age, (years) | 57 ± 14 | 61 ± 12 | 61 ± 12 | P<0.01 |
| BMI, (kg/m2) | 29.0 ± 6.5 | 31.1 ± 7.7 | 33.6 ± 8.7 | P<0.01 |
| Female Gender, n (%) | 1,741 (60%) | 685 (60%) | 92 (56%) | P = 0.53 |
| BG> 180 mg/dl, n (%) | 171 (6.4%) | 113 (10.6%) | 50 (30.5%) | P < 0.001 |
E.W. Duggan: None. V.N. O'Reilly-Shah: None. K.G. Tsegka: None. R.J. Galindo: None. G.E. Umpierrez: Research Support; Self; Sanofi US, Merck & Co., Inc., Novo Nordisk Inc., AstraZeneca. Advisory Panel; Self; Sanofi, Intarcia Therapeutics, Inc..
