Hospitalization is considered an opportunity to improve long-term glycemic control in patients with poor glycemic control at the time of admission. Previous studies have shown an improvement in HbA1c at 3 months, followed by deterioration at 1 year after discharge. In a randomized controlled trial of patients with high HbA1c (≥8%) undergoing an elective surgery, we found that continued care (CC) by a hospital diabetes care team as compared to the usual care (UC) had no significant effect on HbA1c at 1 year after discharge. Here, we present a secondary analysis of these data to evaluate the effect of type of surgery on our outcomes. We hypothesized that patients undergoing an orthopedic surgery may have a higher reduction in HbA1c in response to our intervention. Out of 151 patients, 35 patients had undergone an orthopedic surgery, 18 in the CC group and 17 in the UC group. Baseline characteristics and clinical outcomes are shown in Table 1. Patients undergoing an orthopedic surgery had a significant reduction in HbA1c in the CC group while those in the UC group had no change at one year. In contrast, patients undergoing a non-orthopedic elective surgery had similar reduction in HbA1c in the CC and UC groups. These data suggest that the effect of intervention to improve long-term glycemic control after discharge from the hospital is affected by the hospital diagnosis.

Table 1. Patient characteristics and clinical outcomes.

 Orthopedic Surgery Non-orthopedic Surgery 
Variable CC groupN=18 UC groupN=17 P value CC groupN=59 UC groupN=57 P value 
Age, years 67±7 64±11 0.37 64±10 62±10 0.28 
Female Gender 6 (33) 4 (23) 0.51 29 (49) 21 (37) 0.18 
White Race 18 (100) 15 (88) 0.13 55 (93) 55 (96) 0.40 
Duration of diabetes, years 12.4±10.6 12.8±6.7 0.91 11.2±8.2 12.2±9.8 0.55 
BMI, kg/m2 34.7±8.6 38.0±13.0 0.39 35.2±8.5 33.5±8.1 0.31 
Serum Creatinine, mg/dL 0.86±0.15 0.88±0.24 0.85 1.1±0.6 1.1±0.5 0.90 
eGFR, mL/min 58.5±3.4 59.3±5.4 0.88 55.0±11.0 55.5±9.7 0.82 
Baseline HbA1c 8.5±0.4 8.9±0.7 0.03 9.0±1.1 9.2±1.2 0.25 
HbA1c at 1-year after discharge 7.8±1.0 8.9±1.3 0.01 8.3±1.4 8.4±1.5 0.76 
Change in HbA1c at 1-year from baseline 0.7±0.9 0.0±1.2 0.05 0.7±1.5 0.9±1.6 0.56 
 Orthopedic Surgery Non-orthopedic Surgery 
Variable CC groupN=18 UC groupN=17 P value CC groupN=59 UC groupN=57 P value 
Age, years 67±7 64±11 0.37 64±10 62±10 0.28 
Female Gender 6 (33) 4 (23) 0.51 29 (49) 21 (37) 0.18 
White Race 18 (100) 15 (88) 0.13 55 (93) 55 (96) 0.40 
Duration of diabetes, years 12.4±10.6 12.8±6.7 0.91 11.2±8.2 12.2±9.8 0.55 
BMI, kg/m2 34.7±8.6 38.0±13.0 0.39 35.2±8.5 33.5±8.1 0.31 
Serum Creatinine, mg/dL 0.86±0.15 0.88±0.24 0.85 1.1±0.6 1.1±0.5 0.90 
eGFR, mL/min 58.5±3.4 59.3±5.4 0.88 55.0±11.0 55.5±9.7 0.82 
Baseline HbA1c 8.5±0.4 8.9±0.7 0.03 9.0±1.1 9.2±1.2 0.25 
HbA1c at 1-year after discharge 7.8±1.0 8.9±1.3 0.01 8.3±1.4 8.4±1.5 0.76 
Change in HbA1c at 1-year from baseline 0.7±0.9 0.0±1.2 0.05 0.7±1.5 0.9±1.6 0.56 

Data are presented as mean with SD for continuous variables and N with % for categorical variables.

Disclosure

R. Garg: None. S. Bhandari: None. R. Rein: None. M.E. McDonnell: None.

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