Screening detected unknown diabetes or prediabetes in one-fourth of elective surgery patients
Among elective surgery patients, nearly one-fourth (24%) were diagnosed with previously unknown diabetes or prediabetes based on blood tests conducted while they were fasting preoperatively, researchers found.
Among elective surgery patients, nearly one-fourth (24%) were diagnosed with previously unknown diabetes or prediabetes based on blood tests conducted while they were fasting preoperatively, researchers found.
To assess whether diabetes testing could be incorporated into the elective surgical work-up, researchers conducted a prospective observational study among 275 patients undergoing elective total knee or hip arthroplasty or elective lumbar decompression and/or fusion who had a preoperative visit between December 2007 and November 2008 at a large Wisconsin academic medical center.
The mean patient age was 60.3 years, and 88% had a body mass index greater than 25 kg/m2. All of the patients had insurance; 97% had a primary care clinician, and 96.6% of patients had seen a primary clinician within the past year. Fasting blood glucose (FBG) was drawn immediately before surgery, and patients with preoperative FBG greater than 100 mg/dL had another blood sample taken six to eight weeks postoperatively.
Results appeared online Aug. 7 at the Journal of Hospital Medicine.
In the study, 18% of patients had known diabetes or prediabetes, and 58% were normoglycemic. The other 24% were found to have previously unrecognized diabetes or impaired fasting glucose based on both preop FBG and follow-up FBG. Sixty-four percent of patients with FBG greater than 100 mg/dL preoperatively still had an elevated value at their follow-up visit.
Researchers noted that with more than 1 million total knee and hip operations done in the U.S. annually, such screening could potentially identify more than a quarter-million previously unknown cases of diabetes or prediabetes. Considering that 70 million patients undergo ambulatory or inpatient procedures each year, if one quarter of them allowed for easy preoperative testing, then more than 4 million cases of diabetes and impaired fasting glucose could be found annually. Accountable care organizations may encourage such novel interventions, the authors noted.
Researchers said, “Remarkably, this statistic [24%] likely represents a ‘best case scenario,’ as the percent of undiagnosed patients is likely higher in uninsured patients, those without primary care visits, and those hospitalized for emergent or urgent reasons who, by definition, did not have an ambulatory preoperative evaluation, and who may also have greater severity of illness at baseline.”