Ngaage Ledibabari M, Osadebey Emmanuel N, Tullie Sebastian T E, Elegbede Adekunle, Rada Erin M, Spanakis Elias K, Goldberg Nelson, Slezak Sheri, Rasko Yvonne M
Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md.
Department of Orthopaedic Surgery, Howard University Hospital, Wash.
Plast Reconstr Surg Glob Open. 2019 May 16;7(5):e2240. doi: 10.1097/GOX.0000000000002240. eCollection 2019 May.
Glycemic control represents a modifiable preoperative risk factor in surgery. Traditionally, hemoglobin A1c (HbA1c) and plasma glucose are utilized as measures of glycemic control. However, studies show mixed results regarding the ability of these conventional measures to predict adverse surgical outcomes. This may be explained by the time window captured by HbA1c and serum glucose: long-term and immediate glycemic control, respectively. Fructosamine, glycosylated albumin, and 1,5-anhydroglucitol constitute alternative metrics of glycemic control that are of growing interest but are underutilized in the field of surgery. These nontraditional measures reflect the temporal variations in glycemia over the preceding days to weeks. Therefore, they may more accurately reflect glycemic control within the time window that most significantly affects surgical outcomes. Additionally, these alternative measures are predictive of negative outcomes, even in the nondiabetic population and in patients with chronic renal disease and anemia, for whom HbA1c performs poorly. Adopting these newer metrics of glycemia may enhance the value of preoperative evaluation, such that the effectiveness of any preoperative glycemic control interventions can be assessed, and adverse outcomes associated with hyperglycemia better predicted. The goal of this review is to provide an update on the preoperative management of glycemia and to describe alternative metrics that may improve our ability to predict and control for the negative outcomes associated with poor glycemic control.
血糖控制是手术中一个可改变的术前风险因素。传统上，糖化血红蛋白（HbA1c）和血浆葡萄糖被用作血糖控制的指标。然而，关于这些传统指标预测不良手术结局能力的研究结果不一。这可能是由于HbA1c和血清葡萄糖所反映的时间窗不同：分别为长期和即时血糖控制。果糖胺、糖化白蛋白和1,5-脱水葡萄糖醇构成了血糖控制的替代指标，这些指标越来越受到关注，但在手术领域的应用却很少。这些非传统指标反映了过去几天到几周内血糖的时间变化。因此，它们可能更准确地反映在对手术结局影响最大的时间窗内的血糖控制情况。此外，即使在非糖尿病患者、慢性肾病患者和贫血患者中，HbA1c表现不佳时，这些替代指标也能预测不良结局。采用这些更新的血糖指标可能会提高术前评估的价值，从而可以评估任何术前血糖控制干预措施的有效性，并更好地预测与高血糖相关的不良结局。本综述的目的是提供术前血糖管理的最新情况，并描述可能提高我们预测和控制与血糖控制不佳相关不良结局能力的替代指标。
