Simple Test Predicts Post-Operative Complications in Diabetes Patients

Serum fructosamine better predicted adverse outcomes following total joint arthroplasty among patients with diabetes and prediabetes than glycated hemoglobin (HbA_1c), according to a recent study.

For their study, the researchers conducted preoperative screening of blood glucose levels, fructosamine, and HbA_1c of 829 patients undergoing primary total joint arthroplasty. The cutoff for poor glycemic control was defined as 7%, based on the American Diabetes Association recommendations, which correlated with a threshold fructosamine level of 292 μmol/L. Patients were stratified based on fructosamine levels above and below the threshold. The researchers evaluated complications following arthroplasty, which included surgical-site infection, and compared the rates of complications between those above or below the threshold.
___________________________________________________________________________
RELATED CONTENT
Glycemic Control Is Not Associated With Lifestyle Intervention
Study: Bariatric Surgery Improves Glycemic Control in Patients with Diabetes
___________________________________________________________________________

A total of 119 patients (14.4%) had diabetes and 308 patients (37.2%) had HbA_1c within the prediabetes range. Fifty-one patients had fructosamine levels of 292 μmol/L or more and 20 patients (39.2%) had fructosamine levels of 292 μmol/L or more but did not have an HbA_1c level of 7% or more.

Compared with patients with fructosamine levels of 292 μmol/L or lower, patients with fructosamine levels at or above the threshold had a significantly higher risk for deep surgical-site infections (odds ratio [OR] 6.2], readmission [OR 3], and reoperation [OR 3.4].

In addition, the researchers found that HbA_1c levels of 7% or more did not show any significant correlation with the risk for readmission, reoperation, or deep surgical-site infections.

“Serum fructosamine is a simple and inexpensive test that appears to be a good predictor of adverse outcome in patients with known diabetes and those with unrecognized diabetes or hyperglycemia,” the researchers concluded. “Our findings suggest that fructosamine can serve as an alternative to HbA1c in the setting of preoperative glycemic assessment.”

—Melissa Weiss

Reference:

Shohat N, Tarabichi M, Tischler EH, Jabbour S, Parvizi J. Serum fructosamine: a simple and inexpensive test for assessing preoperative glycemic control [published online Novemer 11, 2017]. J Bone Joint Surg. doi:10.2106/JBJS.17.00075.