Perioperative Glucose Not A1c Predicts Death

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A1C is not associated with increased 30-day mortality after controlling for glucose
A1C is not associated with increased 30-day mortality after controlling for glucose

(HealthDay News) -- Perioperative glucose predicts 30-day mortality linearly in noncardiac surgical patients and nonlinearly in cardiac surgical patients, according to a study published online in Diabetes Care.

Willem van den Boom, from Duke University in Durham, NC, and colleagues assessed the association of preoperative hemoglobin A1c (A1C) with perioperative glucose control and their relationship with 30-day mortality among 6684 noncardiac and 6393 cardiac surgeries.

The researchers found that A1C and glucose were strongly associated. For noncardiac cases, glucose and mortality were positively associated with 1.0% mortality at mean glucose of 100 mg/dL and 1.6% at mean glucose of 200 mg/dL. There was a striking U-shaped relationship between glucose and mortality among cardiac patients, with 4.5% mortality at 100 mg/dL to 1.5% at 140 mg/dL and 6.9% at 200 mg/dL. When controlling for glucose, A1C and 30-day mortality were not associated in either noncardiac or cardiac procedures.

"This confirms that perioperative glucose control is related to surgical outcomes, but that A1C, reflecting antecedent glycemia, is a less useful predictor," the authors write.

Reference

van den Boom W, Schroeder RA, Manning MW, Setji TW, Fiestan GO, and Dunson DB. Effect of A1C and Glucose on Postoperative Mortality in Noncardiac and Cardiac Surgeries. Diab Care 2018 Feb;dc172232. doi:10.2337/dc17-2232

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