Presurgical Diabetics Imperiled When Glucose Is Normal

Diabetic patients who presented for noncardiac surgery with near normal blood sugar levels were at increased risk of death, as compared with their nondiabetic counterparts.

There appears to be the relationship between blood sugar levels before surgery and the occurrence of complications and death after noncardiac surgeries, comparing the relationship between those with diabetes and those without.

In a study carried out at the Cleveland Clinic (Cleveland, OH, USA), specific data from surgeries on 61,536 patients who had elective surgery between January 2005 and November 2009, were analyzed. The overall findings were that 15.8% had diabetes. The study examined two main outcomes: in-hospital complications after surgery (including cardiac, neurological, urologic, and infectious complications) and death within one year of surgery. The study analyzed such associations using both crude and adjusted figures. The adjusted figures took into account other factors that may have contributed to poor outcomes, such as age and heart disease.

The study found that the relationship between blood sugar levels and the likelihood of complications after surgery was not significantly different between diabetics and nondiabetics. However, the investigation showed a significant difference between diabetics and nondiabetics in terms of the relationship between blood sugar levels before surgery and deaths within one year of surgery. Nondiabetic patients with high blood sugar levels had a higher risk of dying from noncardiac surgery compared with diabetics with high blood sugar levels. Conversely, normal blood sugar levels in diabetics were associated with a higher risk of death within one year after noncardiac surgery versus nondiabetics.

Basem Abdelmalak, M.D., the study investigator, said, " Diabetics who have lived with high blood sugar for long periods of time have become accustomed to this state and may have reset their metabolism, becoming unable to tolerate lower blood glucose levels. This is similar to what happens to patients with long-term high blood pressure." The clinical study was presented at the annual meeting of the American Society of Anesthesiologist, held October 16-20, 2010, in San Diego, CA, USA.

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