Preoperative Glycosylated Haemoglobin Screening to Identify Older Adult Patients with Undiagnosed Diabetes Mellitus—A Retrospective Cohort Study
More than 25% of older adults in Europe have diabetes mellitus. It is estimated that 45% of patients with diabetes are currently undiagnosed, which is a known risk factor for perioperative morbidity. We investigated whether routine HbA1c screening in older adult patients undergoing surgery would ide...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-02-01
|
| Series: | Journal of Personalized Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4426/14/2/219 |
| _version_ | 1797297733360418816 |
|---|---|
| author | Robert van Wilpe Mark L. van Zuylen Jeroen Hermanides J. Hans DeVries Benedikt Preckel Abraham H. Hulst |
| author_facet | Robert van Wilpe Mark L. van Zuylen Jeroen Hermanides J. Hans DeVries Benedikt Preckel Abraham H. Hulst |
| author_sort | Robert van Wilpe |
| collection | DOAJ |
| description | More than 25% of older adults in Europe have diabetes mellitus. It is estimated that 45% of patients with diabetes are currently undiagnosed, which is a known risk factor for perioperative morbidity. We investigated whether routine HbA1c screening in older adult patients undergoing surgery would identify patients with undiagnosed diabetes. We included patients aged ≥65 years without a diagnosis of diabetes who visited the preoperative assessment clinic at the Amsterdam University Medical Center and underwent HbA1c screening within three months before surgery. Patients undergoing cardiac surgery were excluded. We assessed the prevalence of undiagnosed diabetes (defined as HbA1c ≥ 48 mmol·mol<sup>−1</sup>) and prediabetes (HbA1c 39–47 mmol·mol<sup>−1</sup>). Using a multivariate regression model, we analysed the ability of HbA1c to predict days alive and at home within 30 days after surgery. From January to December 2019, we screened 2015 patients ≥65 years at our clinic. Of these, 697 patients without a diagnosis of diabetes underwent HbA1c screening. The prevalence of undiagnosed diabetes and prediabetes was 3.7% (95%CI 2.5–5.4%) and 42.9% (95%CI 39.2–46.7%), respectively. Preoperative HbA1c was not associated with days alive and at home within 30 days after surgery. In conclusion, we identified a small number of patients with undiagnosed diabetes and a high prevalence of prediabetes based on preoperative HbA1c screening in a cohort of older adults undergoing non-cardiac surgery. The relevance of prediabetes in the perioperative setting is unclear. Screening for HbA1c in older adult patients undergoing non-cardiac surgery does not appear to help predict postoperative outcome. |
| first_indexed | 2024-03-07T22:24:40Z |
| format | Article |
| id | doaj.art-524577f46587422ab6a52fcf08bd7b33 |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-07T22:24:40Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-524577f46587422ab6a52fcf08bd7b332024-02-23T15:23:53ZengMDPI AGJournal of Personalized Medicine2075-44262024-02-0114221910.3390/jpm14020219Preoperative Glycosylated Haemoglobin Screening to Identify Older Adult Patients with Undiagnosed Diabetes Mellitus—A Retrospective Cohort StudyRobert van Wilpe0Mark L. van Zuylen1Jeroen Hermanides2J. Hans DeVries3Benedikt Preckel4Abraham H. Hulst5Department of Anaesthesiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, The NetherlandsDepartment of Anaesthesiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, The NetherlandsDepartment of Anaesthesiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, The NetherlandsDepartment of Endocrinology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, The NetherlandsDepartment of Anaesthesiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, The NetherlandsDepartment of Anaesthesiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ Amsterdam, The NetherlandsMore than 25% of older adults in Europe have diabetes mellitus. It is estimated that 45% of patients with diabetes are currently undiagnosed, which is a known risk factor for perioperative morbidity. We investigated whether routine HbA1c screening in older adult patients undergoing surgery would identify patients with undiagnosed diabetes. We included patients aged ≥65 years without a diagnosis of diabetes who visited the preoperative assessment clinic at the Amsterdam University Medical Center and underwent HbA1c screening within three months before surgery. Patients undergoing cardiac surgery were excluded. We assessed the prevalence of undiagnosed diabetes (defined as HbA1c ≥ 48 mmol·mol<sup>−1</sup>) and prediabetes (HbA1c 39–47 mmol·mol<sup>−1</sup>). Using a multivariate regression model, we analysed the ability of HbA1c to predict days alive and at home within 30 days after surgery. From January to December 2019, we screened 2015 patients ≥65 years at our clinic. Of these, 697 patients without a diagnosis of diabetes underwent HbA1c screening. The prevalence of undiagnosed diabetes and prediabetes was 3.7% (95%CI 2.5–5.4%) and 42.9% (95%CI 39.2–46.7%), respectively. Preoperative HbA1c was not associated with days alive and at home within 30 days after surgery. In conclusion, we identified a small number of patients with undiagnosed diabetes and a high prevalence of prediabetes based on preoperative HbA1c screening in a cohort of older adults undergoing non-cardiac surgery. The relevance of prediabetes in the perioperative setting is unclear. Screening for HbA1c in older adult patients undergoing non-cardiac surgery does not appear to help predict postoperative outcome.https://www.mdpi.com/2075-4426/14/2/219HbA1cpreoperativeundiagnosed diabetes |
| spellingShingle | Robert van Wilpe Mark L. van Zuylen Jeroen Hermanides J. Hans DeVries Benedikt Preckel Abraham H. Hulst Preoperative Glycosylated Haemoglobin Screening to Identify Older Adult Patients with Undiagnosed Diabetes Mellitus—A Retrospective Cohort Study Journal of Personalized Medicine HbA1c preoperative undiagnosed diabetes |
| title | Preoperative Glycosylated Haemoglobin Screening to Identify Older Adult Patients with Undiagnosed Diabetes Mellitus—A Retrospective Cohort Study |
| title_full | Preoperative Glycosylated Haemoglobin Screening to Identify Older Adult Patients with Undiagnosed Diabetes Mellitus—A Retrospective Cohort Study |
| title_fullStr | Preoperative Glycosylated Haemoglobin Screening to Identify Older Adult Patients with Undiagnosed Diabetes Mellitus—A Retrospective Cohort Study |
| title_full_unstemmed | Preoperative Glycosylated Haemoglobin Screening to Identify Older Adult Patients with Undiagnosed Diabetes Mellitus—A Retrospective Cohort Study |
| title_short | Preoperative Glycosylated Haemoglobin Screening to Identify Older Adult Patients with Undiagnosed Diabetes Mellitus—A Retrospective Cohort Study |
| title_sort | preoperative glycosylated haemoglobin screening to identify older adult patients with undiagnosed diabetes mellitus a retrospective cohort study |
| topic | HbA1c preoperative undiagnosed diabetes |
| url | https://www.mdpi.com/2075-4426/14/2/219 |
| work_keys_str_mv | AT robertvanwilpe preoperativeglycosylatedhaemoglobinscreeningtoidentifyolderadultpatientswithundiagnoseddiabetesmellitusaretrospectivecohortstudy AT marklvanzuylen preoperativeglycosylatedhaemoglobinscreeningtoidentifyolderadultpatientswithundiagnoseddiabetesmellitusaretrospectivecohortstudy AT jeroenhermanides preoperativeglycosylatedhaemoglobinscreeningtoidentifyolderadultpatientswithundiagnoseddiabetesmellitusaretrospectivecohortstudy AT jhansdevries preoperativeglycosylatedhaemoglobinscreeningtoidentifyolderadultpatientswithundiagnoseddiabetesmellitusaretrospectivecohortstudy AT benediktpreckel preoperativeglycosylatedhaemoglobinscreeningtoidentifyolderadultpatientswithundiagnoseddiabetesmellitusaretrospectivecohortstudy AT abrahamhhulst preoperativeglycosylatedhaemoglobinscreeningtoidentifyolderadultpatientswithundiagnoseddiabetesmellitusaretrospectivecohortstudy |