Epidemiology of preoperative hyperglycaemia among patients undergoing surgery at a tertiary health care facility of Eastern India

Authors

  • Souvik Banerjee Department of Anaesthesiology, IQ City Medical College and Multispecialty Hospital, Durgapur, West Bengal, India
  • Rakesh Kumar Department of Community Medicine; Integrated Diabetes and Gestational Diabetes Clinic, IQ City Medical College and Multispecialty Hospital, Durgapur, West Bengal India
  • Debasis Basu Diabetes Awareness and You, Kolkata, West Bengal, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20192812

Keywords:

T2DM, Preoperative hyperglycaemia, Perioperative hyperglycaemia, HbA1C, Stress hyperglycaemia

Abstract

Background: With about 425 million patients globally and 72.9 million patients in India, diabetes mellitus (DM) is one of the global health emergency of 21st century. Perioperative hyperglycaemia is reported in 20-40% of patients undergoing general surgery. A substantial body of literature demonstrates a clear association between perioperative hyperglycaemia and adverse clinical outcomes. This study aims to find out the frequency of preoperative hyperglycaemia and factors influencing it among patients undergoing surgery at a tertiary health care hospital of Eastern India.

Methods: This Institution based, cross-sectional, observational study was conducted among study subjects who were operated at IQ City Medical College and Multispecialty Hospital, Durgapur, India during January-February 2019. Relevant medical records were reviewed to collect data regarding clinic-social data. Estimation of fasting plasma glucose (FPG) has been done as per World Health Organization (WHO) guidelines. Hyperglycaemia was defined and classified as per American Diabetes Association (ADA). Anthropometric measurements were taken as per standard WHO protocols.

Results: A total 158 study subjects participated in study. The mean age and mean FPG of the study subjects was 42.63±12.95 years and 103.3±17.37 mg/dl respectively. As per the ADA criteria, 58.9% had normal FPG, 24.0% had impaired fasting glucose (IFG) and 17.1% had diabetes. Out of total 27 T2DM patients, 22 (13.9%) were known cases of T2DM and 5 (3.2%) were undiagnosed. The frequency of preoperative hyperglycaemia i.e. sums of IFG and diabetes was found to be 41.1%. Increasing age, male gender and overweight and obesity significantly influenced the occurrence of preoperative hyperglycaemia.

Conclusions: The prevalence of preoperative hyperglycaemia among patients undergoing surgery is higher than the prevalence of hyperglycaemia among non surgical patients. Routine HbA1C should be done in all surgical patients to differentiate between chronic undiagnosed hyperglycaemia and stress hyperglycaemia.

Metrics

Metrics Loading ...

References

Thakur JK, Kumar R, Basu D, Hansda K, Munshi BD, Chakraborty SN, et al. Prevalence of Diabetic Foot Syndrome and Its Determinants among Type 2 Diabetes Mellitus patients attending Integrated Diabetes & Gestational Diabetes Clinic of a Tertiary Health Care Level Hospital of Eastern India. IOSR J Dent Med Sci. 2019;18(1):24-9.

IDF Diabetes atlas 8th Edition; International Diabetes Federation. 2017. Available at: www.diabetesatlas.org Accessed on 3 March 2019.

Roper NA, Bilous RW, KellyWF, Unwin NC, Connolly VM. Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study. BMJ. 2001;322:1389–93.

Currie CJ, Gale EA, Poole CD. Estimation of primary care treatment costs and treatment efficacy for people with type 1 and type 2 diabetes in the United Kingdom from 1997 to 2007. Diabet Med. 2010;27:938–48.

Manuel DG, Schultz SE. Health-related quality of life and health-adjusted life expectancy of people with diabetes in Ontario, Canada, 1996-1997. Diabetes Care. 2004;27:407–14.

Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, Williams BA, et al. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc. 2005;80:862-6.

Ouattara A, Lecomte P, Le Manach Y, Landi M, Jacqueminet S, Platonov I, et al. Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. Anesthesiology. 2005;103:687-94.

Kersten JR, Pagel PS, Warltier DC. Aggressive control of intraoperative blood glucose concentration - a shifting paradigm? Anesthesiology. 2005;103:677-8.

Frisch A, Chandra P, Smiley D, Peng L, Rizzo M, Gatfcliffe C, et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care. 2010;33(8):1783–8.

Cook CB, Kongable GL, Potter DJ, Abad VJ, Leija DE, Anderson M. Inpatient glucose control:a glycemic survey of 126 U.S. hospitals. J Hosp Med. 2009;4(9):E7–E14.

Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D. Importance of perioperative glycemic control in general surgery:a report from the Surgical Care and Outcomes Assessment Program. Ann Surg. 2013;257(1):8–14.

Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia:an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87(3):978–82.

Kotagal M, Symons RG, Hirsch IB, Umpierrez GE, Farrokhi ET, Flum DR, SCOAP-Certain Collaborative. Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Ann Surg. 2015;261(1):97–103.

Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, Hirsch IB, Hirsh IB. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27:553–91.

Smiley DD, Umpierrez GE. Perioperative glucose control in the diabetic or nondiabetic patient. South Med J. 2006;99:580– 91.

Edelson GW, Fachnie JD, Whitehouse FW. Perioperative management of diabetes. Henry Ford Hosp Med J. 1990;38:262–5.

Noordzij PG, Boersma E, Schreiner F, Kertai MD, Feringa HH, Dunkelgrun M, et al. Increased preoperative glucose levels are associated with perioperative mortality in patients undergoing noncardiac, nonvascular surgery. Eur J Endocrinol. 2007;156:137–142.

Pomposelli JJ, Baxter JK 3rd, Babineau TJ, Pomfret EA, Driscoll DF, Forse RA, Bistrian BR. Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. JPEN J Parenter Enteral Nutr. 1998;22:77–81.

World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia :report of a WHO/IDF consultation; Geneva, 2006.

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(Suppl 1):S81–S90.

The International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32:1327–1334.

World Health Organization. Waist circumference and waist-hip ratio: Report of a WHO expert consultation; Geneva, 2008.

Levetan CS, Passaro M, Jablonski K, Kass M, Ratner RE. Unrecognized diabetes among hospitalized patients. Diabetes Care. 1993;21:246–9.

Barik A, Mazumdar S, Chowdhury A, Rai RK. Physiological and behavioral risk factors of type 2 diabetes mellitus in rural India. BMJ Open Diabetes Res Care. 2016;4(1):e000255.

Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK, et al. High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia. 2001;44(9):1094–101.

Little M, Humphries S, Patel K, Dodd W, Dewey C. Factors associated with glucose tolerance, pre-diabetes, and type 2 diabetes in a rural community of south India:a cross-sectional study. Diabetol Metab Syndr. 2016;8:21.

Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/ or impaired glucose tolerance) in urban and rural India:phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia. 2011;54(12):3022–7.

D Roberts, T Meakem, C Dalton, D Haverstick, C Lynch III. Prevalence of Hyperglycemia in a Pre-Surgical Population. Internet J Anesthesiol. 2006;12(1):1.

Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289:76-9.

Meshram II, Vishnu Vardhana Rao M, Sudershan Rao V, Laxmaiah A, Polasa K. Regional variation in the prevalence of overweight/obesity, hypertension and diabetes and their correlates among the adult rural population in India. Br J Nutr. 2016;115(7):1265–72.

Goswami AK, Gupta SK, Kalaivani M, Nongkynrih B, Pandav CS. Burden of hypertension and diabetes among urban population aged ≥60 years in South Delhi:a community based study. J Clin Diagn Res. 2016;10(3):LC01-5.

Ravikumar P, Bhansali A, Ravikiran M, Bhansali S, Walia R, Shanmugasundar G, et al. Prevalence and risk factors of diabetes in a community-based study in North India:the Chandigarh Urban Diabetes Study (CUDS). Diabetes Metab. 2011;37(3):216–21.

Chan JCN, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon K-H, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301(20):2129–40.

Ahmed A. A study on prevalence of hypothyroidism in diabetics. Int J Med Sci Educ. 2014;1:120-4.

Dimitriadis G, Mitrou P, Lambadiari V. Insulin action in adipose tissue and muscle in hypothyroidism. J Clin Endocrinol Metab. 2006;91:4930–7.

Teixeira SS, Tamrakar AK, Goulart-Silva F, Serrano-Nascimento C, Klip A, Nunes MT. Triiodothyronine acutely stimulates glucose transport into L6 muscle cells without increasing surface GLUT4, GLUT1, or GLUT3. Thyroid. 2012;22:747–754.

Roos A, Bakker SJ, Links TP, Gans RO, Wolffenbuttel BH. Thyroid function is associated with components of the metabolic syndrome in euthyroid subjects. J Clin Endocrinol Metab. 2007;92:491–6.

Ruhla S, Weickert MO, Arafat AM, et al. A high normal TSH is associated with the metabolic syndrome. Clin Endocrinol (Oxf). 2010;72:696–701.

Maratou E, Hadjidakis DJ, Kollias A, et al. Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. Eur J Endocrinol 2009;160:785–90.

Weinstein SP, O’Boyle E, Fisher M, Haber RS. Regulation of GLUT2 glucose transporter expression in liver by thyroid hormone:evidence for hormonal regulation of the hepatic glucose transport system. Endocrinology. 1994;135:649–54.

Downloads

Published

2019-06-28

How to Cite

Banerjee, S., Kumar, R., & Basu, D. (2019). Epidemiology of preoperative hyperglycaemia among patients undergoing surgery at a tertiary health care facility of Eastern India. International Journal Of Community Medicine And Public Health, 6(7), 2838–2843. https://doi.org/10.18203/2394-6040.ijcmph20192812

Issue

Section

Original Research Articles