Van Herk Peter, Morin Nathaniel, Dersch-Mills Deonne, Roedler Rhonda, Ang Beverly, Olivieri Lori
, BSc, MSc, ACPR, PharmD, is with the Inpatient Pharmacy, Chinook Regional Hospital, Lethbridge, Alberta.
, BScPharm, is with the Inpatient Pharmacy, South Health Campus, Calgary, Alberta.
Can J Hosp Pharm. 2022 Winter;75(1):34-40. doi: 10.4212/cjhp.v75i1.3253.
Patients with diabetes are more likely to undergo a surgical procedure than the rest of the population, and it is well established that preoperative hyperglycemia is associated with adverse surgical outcomes. However, it is currently unknown what factors increase the odds of preoperative hyperglycemia in people with diabetes.
To identify patient characteristics that increase the risk of preoperative hyperglycemia.
This retrospective case-control study compared 100 patients with preoperative hyperglycemia on admission for elective surgery at South Health Campus in Calgary, Alberta (blood glucose > 10.9 mmol/L) with 200 controls who did not have preoperative hyperglycemia on admission for elective surgery (blood glucose ≤ 10.9 mmol/L). Multivariate logistic regression was used to identify risk factors for preoperative hyperglycemia.
In the univariate analysis, age, number of comorbidities, increasing glycated hemoglobin (HbA), type of diabetes, type of procedure, and diabetes medications (non-insulin, insulin, both, or none) were associated with increased odds of preoperative hyperglycemia ( < 0.05). However, in the adjusted analysis, only increasing HbA (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.36-2.12) and type 1 diabetes (OR 4.24, 95% CI 1.11-16.21, relative to type 2 diabetes) were associated with preoperative hyperglycemia.
These results can help clinicians to identify patients who may be at increased risk of hyperglycemia before an elective procedure. They also allow for treatment of those who would benefit most from additional guidance with regard to preoperative glucose management.
糖尿病患者比其他人群更有可能接受外科手术，并且术前高血糖与不良手术结局相关这一点已得到充分证实。然而，目前尚不清楚哪些因素会增加糖尿病患者术前高血糖的几率。
确定增加术前高血糖风险的患者特征。
这项回顾性病例对照研究将艾伯塔省卡尔加里市南部健康校区因择期手术入院时存在术前高血糖（血糖>10.9 mmol/L）的100例患者与因择期手术入院时不存在术前高血糖（血糖≤10.9 mmol/L）的200例对照进行了比较。采用多因素逻辑回归来确定术前高血糖的危险因素。
在单因素分析中，年龄、合并症数量、糖化血红蛋白（HbA）升高、糖尿病类型、手术类型以及糖尿病药物治疗情况（非胰岛素、胰岛素、两者都用或都不用）与术前高血糖几率增加相关（P<0.05）。然而，在校正分析中，只有HbA升高（比值比[OR]1.69，95%置信区间[CI]1.36 - 2.12）和1型糖尿病（相对于2型糖尿病，OR 4.24，95% CI 1.11 - 16.21）与术前高血糖相关。
这些结果有助于临床医生识别择期手术前可能有更高高血糖风险的患者。它们还能让那些最能从术前血糖管理的额外指导中获益的患者得到治疗。
