Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Aug 18;20(1):188.
doi: 10.1186/s12893-020-00844-2.

The neglected perioperative population of undiagnosed diabetics - a retrospective cohort study

Wei W Teo  1 , Lian K Ti  2 , Lyn L Lean  2 , Edwin Seet  3 , Ambika Paramasivan  2 , Weiling Liu  2 , Jiexun Wang  3 , Vanessa Chua  2 , Lydia Q Liew  2
Affiliations

The neglected perioperative population of undiagnosed diabetics - a retrospective cohort study

Wei W Teo et al. BMC Surg. .

Abstract

Background: Diabetes is known to increase morbidity and 30-day mortality in adults undergoing non-cardiac surgery, but longer term outcomes are less studied. This study was done to explore how undiagnosed and known diabetes affect 30-day and one-year morbidity and mortality outcomes. The secondary aim was to study the prevalence of undiagnosed diabetics in our perioperative Asian surgical population.

Methods: A retrospective cohort study of 2106 patients aged > 45 years undergoing non-cardiac surgery in a single tertiary hospital was performed. Undiagnosed diabetics were identified (HbA1c ≥6.5% or fasting blood glucose ≥126 mg/dL) and relevant demographic, clinical and surgical data were analyzed to elicit the relationship to adverse outcomes. Univariate analysis was first performed to identify significant variables with p-values ≤0.1, which were then analyzed using multiple logistic regression to calculate the adjusted odds ratio.

Results: The prevalence of undiagnosed diabetes was 7.4%. The mean and median HbA1c of known diabetics were 7.9 and 7.5%, while the mean and median HbA1c for undiagnosed diabetics were 7.2 and 6.8% respectively. 36.4% of known diabetics and 20.5% of undiagnosed diabetics respectively had a random blood glucose > 200 mg/dL. Undiagnosed diabetics had a three-fold increase in 1-year mortality compared to non-diabetics (adjusted OR 3.46(1.80-6.49) p < 0.001) but this relationship was not significant between known and non-diabetics. Compared to non-diabetics, known diabetics were at increased risks of new-onset atrial fibrillation (aOR 2.48(1.01-6.25) p = 0.047), infection (aOR 1.49(1.07-2.07) p = 0.017), 30-day readmission (aOR 1.62(1.17-2.25) p = 0.004) and 30-day mortality (aOR 3.11(1.16-8.56) p = 0.025).

Conclusions: Although undiagnosed diabetics have biochemically less severe disease compared to known diabetics at the point of testing, they are at a one-year mortality disadvantage which is not seen among known diabetics. This worrying trend highlights the importance of identifying and treating diabetes. Congruent to previous studies, known diabetics have higher morbidity and 30-day mortality compared to non-diabetics.

Keywords: Asian; Diabetes mellitus; General surgery; Morbidity; Mortality.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a HbA1c levels amongst known and undiagnosed diabetics in the surgical population. b Fasting blood glucose levels amongst known and undiagnosed diabetics in the surgical population. DM – diabetes mellitus
Fig. 2
Fig. 2
a Box and whisker chart of mean and median HbA1c levels amongst known and undiagnosed diabetics. b Box and whisker chart of mean and median fasting blood glucose levels amongst known and undiagnosed diabetics. x – mean value; DM – diabetes mellitus
See this image and copyright information in PMC

References

    1. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103(2):137–149. - PubMed
    1. Huang ES, Basu A, O’Grady M, Capretta JC. Projecting the future diabetes population size and related costs for the U.S. Diabetes Care. 2009;32(12):2225–2229. - PMC - PubMed
    1. Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators. Devereaux PJ, Chan MTV, Alonso-Coello P, Walsh M, Berwanger O, et al. Association Between Postoperative Troponin Levels and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA. 2012;307(21):2295. - PubMed
    1. Meister KM, Hufford T, Tu C, Khorgami Z, Schauer PR, Brethauer SA, et al. Clinical significance of perioperative hyperglycemia in bariatric surgery: evidence for better perioperative glucose management. Surg Obes Relat Dis. 2018;14(11):1725–1173. - PubMed
    1. van den Boom W, Schroeder RA, Manning MW, Setji TL, Fiestan G-O, Dunson DB. Effect of A1C and Glucose on Postoperative Mortality in Noncardiac and Cardiac Surgeries. Diabetes Care. 2018;41(4):782–788. - PubMed