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Observational Study
. 2024 Sep 9;23(1):333.
doi: 10.1186/s12933-024-02421-w.

High proportion of undiagnosed diabetes in patients surgically treated for infrarenal abdominal aortic aneurysm: findings from the multicentre Norwegian Aortic Aneurysm and Diabetes (ABANDIA) Study

J Wesche  1   2 , T Bakken  3   4   5 , M Vetrhus  4   6 , K O Hufthammer  7 , L Aa Nyroenning  8   9 , H Fagertun  8   9 , I Saethre  10 , B H Wold  11 , C Lyng  12 , E M Pettersen  8   13   14 , I S Kjellsen  6 , E T Gubberud  15 , S Kiil  16 , H Loose  17 , M T Helgeland  2 , M E Altreuther  8   9   14 , E Mattsson  8 , T Jonung  4 , I D Hjellestad  18   19
Affiliations
Observational Study

High proportion of undiagnosed diabetes in patients surgically treated for infrarenal abdominal aortic aneurysm: findings from the multicentre Norwegian Aortic Aneurysm and Diabetes (ABANDIA) Study

J Wesche et al. Cardiovasc Diabetol. .

Abstract

Background: The aim was to investigate the total prevalence of known and undiagnosed diabetes mellitus (DM), and the association of DM with perioperative complications following elective, infrarenal, open surgical (OSR) or endovascular (EVAR), Abdominal Aortic Aneurysm (AAA) repair.

Methods: In this Norwegian prospective multicentre study, 877 patients underwent preoperative screening for DM by HbA1c measurements from November 2017 to December 2020. Diabetes was defined as screening detected HbA1c ≥ 48 mmol/mol (6.5%) or previously diagnosed diabetes. The association of DM with in-hospital complications, length of stay, and 30-day mortality rate were evaluated using adjusted and unadjusted logistic regression models.

Results: The total prevalence of DM was 15% (95% CI 13%,17%), of which 25% of the DM cases (95% CI 18%,33%) were undiagnosed upon admission for AAA surgery. The OSR to EVAR ratio was 52% versus 48%, with similar distribution among DM patients, and no differences in the prevalence of known and undiagnosed DM in the EVAR versus the OSR group. Total 30-day mortality rate was 0.6% (5/877). Sixty-six organ-related complications occurred in 58 (7%) of the patients. DM was not statistically significantly associated with a higher risk of in-hospital organ-related complications (OR 1.23, 95% CI 0.57,2.39, p = 0.57), procedure-related complications (OR 1.48, 95% CI 0.79,2.63, p = 0.20), 30-day mortality (p = 0.09) or length of stay (HR 1.06, 95% CI 0.88,1.28, p = 0.54). According to post-hoc-analyses, organ-related complications were more frequent in patients with newly diagnosed DM (n = 32) than in non-DM patients (OR 4.92; 95% CI 1.53,14.3, p = 0.005).

Conclusion: Twenty-five percent of all DM cases were undiagnosed at the time of AAA surgery. Based on post-hoc analyses, undiagnosed DM seems to be associated with an increased risk of organ related complications following AAA surgery. This study suggests universal DM screening in AAA patients to reduce the number of DM patients being undiagnosed and to improve proactive diabetes care in this population. The results from post-hoc analyses should be confirmed in future studies.

Keywords: Abdominal aortic aneurysm (AAA); Diabetes mellitus (DM); Endovascular aneurysm repair (EVAR); Infrarenal AAA repair; Open surgical aneurysm repair (OSR).

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the Norwegian Abdominal Aortic Aneurysm and Diabetes (ABANDIA) study
Fig. 2
Fig. 2
Prevalence of known and undiagnosed diabetes mellitus (DM) in 877 patients who underwent elective, infrarenal AAA repair (OSR or EVAR) from November 2017 to December 2020. The areas are proportional to the number of patients
See this image and copyright information in PMC

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