The positive impact of a multidisciplinary preoperative diabetes clinic on improving glycaemic management in adults undergoing elective noncardiac surgery
Main finding · HbA1cResult — go to the resultMean reduction −21 mmol/mol 95% CI −24 to −16Authors' conclusion
The multidisciplinary clinic was effective in improving participants' glycaemic control before elective noncardiac surgery. Individuals with the highest baseline HbA1c levels had the greatest preoperative improvement. This study highlights the meaningful impact on glycaemic management that can be achieved in the preoperative period. Parts of this work were previously presented at the 13th Australasian Symposium of the Perioperative Medicine Special Interest Group in collaboration with Summit III and the Perioperative Quality Initiative (POQI), 22-24 November 2024, Melbourne, Australia.
Study context
- Population
- Adults scheduled for elective noncardiac surgery with haemoglobin A1c (HbA1c) ≥64 mmol/mol (8.0%)
- Participants
- 79 adults
- Exposure
- Multidisciplinary preoperative diabetes clinic: baseline vs day of surgery
- Clinicn = 79
- Outcome
- Change in HbA1c and serum fructosamine between baseline and day of surgery
- Follow-up
- Day of surgery
Methodological detailssingle-group, before-after
- Single-group
- Before-after
Main finding
HbA1c · baseline to day of surgery
Mean reduction
−21 mmol/mol
95% CI −24 to −16
P < 0.001
As reported in the abstract
- Mean HbA1c at baseline
- 83 mmol/mol (9.7%)
- Mean HbA1c on day of surgery
- 63 mmol/mol (7.9%)
- Each 1% increase in baseline HbA1c predicted a decrease in day-of-surgery HbA1c of
- −0.759%
Observational data: associations, not effects.
Further findings
Linear regression: baseline HbA1c vs change in HbA1c · baseline to day of surgery
- Significant negative relationship; each 1% increase in baseline HbA1c predicted a decrease in day-of-surgery HbA1c
- −0.759%
Serum fructosamine · baseline to day of surgery
μmol/L
- Median baseline fructosamine
- 361
- Median reduction on day of surgery (IQR −87 to −26 μmol/L, p < 0.001)
- −53
Fructosamine 4 weeks postsurgery vs day of surgery
- No significant change compared with the day of surgery
LOS, in-hospital infections and readmissions
- Median LOS (IQR 1-5)
- 2 days
- Low incidence of in-hospital infections and readmissions in the cohort
Safety
- Low incidence of in-hospital infections and readmissions
Original publication
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