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Perioperative Glucose but Not A1C Predicts Surgical Outcomes

WEDNESDAY, Feb. 21, 2018 -- Perioperative glucose predicts 30-day mortality linearly in noncardiac surgical patients and nonlinearly in cardiac surgical patients, according to a study published online Feb. 13 in Diabetes Care.

Willem van den Boom, from Duke University in Durham, N.C., and colleagues assessed the association of preoperative hemoglobin A1c (A1C) with perioperative glucose control and their relationship with 30-day mortality among 6,684 noncardiac and 6,393 cardiac surgeries.

The researchers found that A1C and glucose were strongly associated. For noncardiac cases, glucose and mortality were positively associated with 1.0 percent mortality at mean glucose of 100 mg/dL and 1.6 percent at mean glucose of 200 mg/dL. There was a striking U-shaped relationship between glucose and mortality among cardiac patients, with 4.5 percent mortality at 100 mg/dL to 1.5 percent at 140 mg/dL and 6.9 percent at 200 mg/dL. When controlling for glucose, A1C and 30-day mortality were not associated in either noncardiac or cardiac procedures.

"This confirms that perioperative glucose control is related to surgical outcomes, but that A1C, reflecting antecedent glycemia, is a less useful predictor," the authors write.

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Posted: February 2018