All Patients Should Be Screened for Diabetes Before Total Joint Arthroplasty

Noam Shohat, Karan Goswami, Majd Tarabichi, Emily Sterbis, Timothy L. Tan, Javad Parvizi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Diabetes is highly prevalent in patients with osteoarthritis before total joint arthroplasty and presents a higher risk of adverse postoperative outcomes. However, the rate of diabetes in this population and optimal screening strategies remain unknown. Methods: We prospectively screened patients undergoing elective total joint arthroplasty for diabetes using glycated hemoglobin (HbA1c) and fasting blood glucose (FBG) levels. Screening was conducted within 2 time periods between 2012 and 2017. The prevalence of diabetes was assessed using a previous diagnosis of diabetes or, in the absence of diagnosis, by measuring if HbA1c ≥ 6.5% or FBG ≥ 126 mg/dL. Prediabetes was defined as 5.7% ≤ HbA1c ≤ 6.4% or 100 mg/dL ≤ FBG ≤ 125 mg/dL. Occurrence of a 90-day periprosthetic joint infection and wound complications was noted. Results: A total of 1461 patients were included in the study. The prevalence of diabetes was 20.6%; 178 patients (59.1%) had diagnosed diabetes, and 123 patients (40.9%) had undiagnosed diabetes. Prediabetes was identified in 559 patients (38.3%), resulting in a combined total of 860 (58.9%) patients with diabetes and prediabetes. Total diabetic rates were significantly higher in patients aged >65 years, of nonwhite ethnicity, and undergoing total knee arthroplasty. No significant differences in periprosthetic joint infection and wound complications were observed while comparing patients with diagnosed and undiagnosed diabetes. Conclusion: A significant proportion of patients with undiagnosed diabetes and prediabetes were identified. Preadmission testing provides an opportunity to identify and address this condition, potentially reducing short-term arthroplasty-related complications and avoiding long-term systemic diabetic complications. We strongly recommend universal glycemic screening to all elective arthroplasty patients.

Original languageEnglish
Pages (from-to)2057-2061
Number of pages5
JournalJournal of Arthroplasty
Volume33
Issue number7
DOIs
StatePublished - Jul 2018

Keywords

  • diabetes
  • glycemic screening
  • hip
  • knee
  • total joint arthroplasty

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