Patients with insulin-dependent diabetes had increased risk of hyperglycemia after TJA

Brian M. Godshaw

LAS VEGAS — Patients with insulin-dependent diabetes undergoing total joint arthroplasty had an increased risk of postoperative hyperglycemia compared with patients with diabetes who were not dependent on insulin preoperatively, according to results presented at the American Academy of Orthopaedic Surgeons Annual Meeting.

“We need to use caution when performing total joint arthroplasty in insulin-dependent diabetics because they are at higher risk for this postoperative hyperglycemia, which per other studies, has been associated with prosthetic joint infection,” Brian M. Godshaw, MD, said in his presentation here.

Godshaw and colleagues stratified 773 patients with diabetes undergoing TJA into whether they had insulin-dependent (n=437) or non-insulin-dependent (n=336) diabetes. To be included in the study, Godshaw noted patients had to have a recorded hemoglobin A1c within 3 months of the procedure.

“Our primary endpoint was a serum glucose greater than 200 [mg/dL] and a secondary endpoint was prosthetic joint infection,” Godshaw said.

Results showed patients who were insulin-dependent had a significantly higher average postoperative glucose level, as well as higher preoperative hemoglobin A1c.

“Nearly 60% [of insulin-dependent patients] had a postoperative glucose greater than 200 [mg/dL] compared to just over 20% in the non-insulin dependent counterparts,” Godshaw said.

However, he noted no significant difference in the rate of prosthetic joint infection between the two groups. Patients in the insulin-dependent group had a 5.2-fold increase in postoperative hyperglycemia greater than 200 mg/dL, according to Godshaw.

“We went back to see if proposing a cutoff value for [hemoglobin] A1c within these patients would lead to a lower rate of postoperative hyperglycemia greater than 200 [mg/dL],” Godshaw said. “We found that there was a significant difference where if we instituted an A1c cutoff of 6.59% in our insulin-dependent group and 6.60% in our non-insulin-dependent group, this would significantly reduce the number of postoperative hyperglycemia greater than 200 [mg/dL].” – by Casey Tingle

Reference:

Godshaw BM, et al. Abstract 759. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 12-16, 2019; Las Vegas.

Disclosure: Godshaw reports no relevant financial disclosures.