Endocrine Abstracts

Purpose: To determine the association between clinical indicators of metabolic state and cardiovascular, infectious and metabolic complications during or after elective surgery in patients with type 2 diabetes mellitus (T2DM) regardless of their treatment scheme.

Methods: Prospective observational study. Patients with T2DM, ages 20–80 years, scheduled for elective surgery were evaluated with office BP, BMI, Hb1Ac, fasting glucose, fibrinogen, total cholesterol, triglycerides, ischemic cardiomyopathy by EKG, and the presence of LVH by echocardiography. Cardiovascular, infectious and metabolic complications during or after elective surgery were registered till the time of discharge. Patients with cetonuria, hypoglycemia or clinical conditions that could interfere with the diagnosis of persistent microalbuminuria and autonomic neuropathy were excluded. Significant associations were determined through chi square tests and linear regression analyses.

Results: Sixty two patients were evaluated (mean age: 60.5 years, 20–80 years range; 69.6% females). The most frequent complications were hypertension (n=21), hyperglycemia (n=24) and surgical wound infection (n=20). Analysis identified a significant association between age (P=0.04; OR: 4.98, S.E.M.: 0.73 (B: 1.60, P=0.02)), Hb1Ac ≥7% (P=0.01; OR: 12.77, S.E.M.: 0.92 (B: 2.54, P=0.006)), EKG with ischemic cardiomyopathy (P=0.04; OR: 4.14, S.E.M.: 0.82 (B: 1.42, P=0.08)) and general anesthesia (P=0.03; OR: 10.63, S.E.M.: 0.83 (B: 2.36, P=0.004)) with more cardiovascular complications during or after surgery; glucemia ≥126 mg/dl (P=0.04; OR: 3.62, S.E.M.: 0.74 (B: 1.28, P=0.08)) and Hb1Ac ≥7% (P=0.01; OR: 6.43, S.E.M.: 0.81 (B: 1.84, P=0.02)) were associated with more metabolic complications during or after surgery; No other parameter measured was significantly associates with cardiovascular, infectious or metabolic complication during or after elective surgery.

Conclusions: Significant association were found between age, Hb1Ac levels, type of anesthesia and EKG with evidence of ischemic cardiomyopathy and cardiovascular complications; preoperative glycaemia and Hb1Ac were associated with metabolic complications. The evaluation of the metabolic status of T2DM patients before elective surgery may help to anticipate trans- or post-operative complications.