Postoperative Glycemic Variability in Diabetic Orthopedic Patients: Association with DVT/Myocardial Infarction and Interactive Risk with HbA1c
Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v6i3.4385
Abstract
This study explored the association of postoperative glycemic variability with 30-day deep vein thrombosis (DVT) and myocardial infarction (MI) in diabetic orthopedic patients, and its interaction with glycated hemoglobin (HbA1c). A retrospective analysis of 826 diabetic patients undergoing elective major orthopedic surgeries (total hip arthroplasty [THA], total knee arthroplasty [TKA], spinal fusion) (2019–2024) was conducted. Glycemic variability indices included mean amplitude of glycemic excursions (MAGE), blood glucose standard deviation (SD), and maximum glycemic fluctuation (Max-G). Multivariate logistic regression and interaction analyses were performed. Results showed 109 (13.2%) DVT cases and 38 (4.6%) MI cases. After adjusting for confounders, each 1 mmol/L increase in MAGE was associated with 2.13-fold higher DVT risk (OR=2.13, 95% CI: 1.68–2.70, P<0.001) and 2.57-fold higher MI risk (OR=2.57, 95% CI: 1.81–3.65, P<0.001). Significant interaction between glycemic variability and HbA1c was observed (Pinteraction<0.05): in patients with HbA1c>9%, DVT (OR=3.02) and MI (OR=3.61) risks were higher than in those with HbA1c<7% (DVT: OR=1.58; MI: OR=1.87). Sensitivity analysis confirmed robustness. Conclusion: Postoperative glycemic variability (especially MAGE) is an independent risk factor for DVT/MI in diabetic orthopedic patients, with significant interaction with HbA1c. Strengthening glycemic variability management is crucial.
Keywords
diabetes mellitus, orthopedic surgery, glycemic variability, deep vein thrombosis, myocardial infarction, glycated hemoglobin
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[1]Chinese Society of Endocrinology and Metabolism. China Guidelines for the Prevention and Treatment of Type 2 Diabetes Mellitus (2023 Edition) [J]. Chinese Journal of Diabetes Mellitus, 2024, 16 (1): 1-60.
[2]Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism in orthopedic surgery patients: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) [J]. Chest, 2008, 133(6 Suppl): 381S-453S.
[3]Chinese Orthopaedic Association, Chinese Trauma Association. China Guidelines for the Prevention of Venous Thromboembolism in Major Orthopedic Surgery (2021 Edition) [J]. Chinese Journal of Orthopaedics, 2021, 41 (20): 1321-1330.
[4]American Diabetes Association. Standards of Medical Care in Diabetes — 2023 [J]. Diabetes Care, 2023, 46(Suppl 1): S1-S29.
[5]Monnier L, Colette C. Glucose variability: the third component of the glycemic triad [J]. Diabetes Metab, 2008, 34(5 Suppl 2): S45-S51.
[6]Li H, Zhou J, Jia W. Relationship between glycemic variability and chronic complications of diabetes mellitus [J]. Chinese Journal of Endocrinology and Metabolism, 2012, 28 (9): 709-712.
[7]Zhang X, Li Y, Wang J, et al. Mean amplitude of glycemic excursions is associated with cardiovascular events in patients with type 2 diabetes mellitus [J]. Journal of Clinical Endocrinology & Metabolism, 2018, 103(10): 3869-3876.
[8]Chen Y, Liu J, Zhang H, et al. Glycemic variability and postoperative complications in diabetic patients undergoing total knee arthroplasty [J]. Journal of Orthopaedic Surgery and Research, 2020, 15(1): 456.
[9]Service FJ, Molnar GD, Rosevear JW, et al. Mean amplitude of glycemic excursions, a measure of diabetic instability [J]. Diabetes, 1970, 19(11): 644-655.
[10]Zhou J, Yu M, Jia W, et al. Evaluation of intraday and interday glycemic variability in patients with type 2 diabetes mellitus by continuous glucose monitoring [J]. Chinese Journal of Endocrinology and Metabolism, 2006, 22 (3): 286-288.
[11]Chinese Orthopaedic Association. China Guidelines for the Prevention of Venous Thromboembolism in Major Orthopedic Surgery (2021 Edition) [J]. Chinese Journal of Orthopaedics, 2021, 41 (20): 1321-1330.
[12]Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018) [J]. Circulation, 2018, 138(20): e618-e651.
[13]Brownlee M. Biochemistry and molecular cell biology of diabetic complications [J]. Nature, 2001, 414(6865): 813-820.
[14]Ceriello A. The possible role of glycemic variability in the development of microvascular complications in type 2 diabetes mellitus [J]. Diabetes Care, 2005, 28(11): 2754-2755.
[15]Zhang L, Wang Y, Li X, et al. Glycemic variability induces endothelial dysfunction via oxidative stress-mediated activation of the NF-κB pathway in type 2 diabetes [J]. Experimental and Therapeutic Medicine, 2022, 24(3): 168.
[16]Marfella R, Portoghese M, Paolisso G. Glucose variability and cardiovascular complications in diabetes mellitus [J]. World Journal of Diabetes, 2015, 6(11): 1291-1298.
[17]Fonseca VA, Burcin M, Bell D, et al. Glycemic variability and cardiovascular outcomes in type 2 diabetes: a post hoc analysis of the EXAMINE trial [J]. Diabetes Care, 2017, 40(8): 1031-1037.
[18]Wang X, Li J, Yang L, et al. Glycemic variability exacerbates myocardial ischemia-reperfusion injury by activating the NLRP3 inflammasome in diabetic rats [J]. International Journal of Molecular Medicine, 2021, 48(3): 163.
[19]Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy [J]. Diabetes Care, 2009, 32(1): 193-203.
[20]Qiu Y, Chen L, Xu X, et al. Interaction between HbA1c and glycemic variability on the risk of microvascular complications in type 2 diabetes [J]. Diabetes Research and Clinical Practice, 2022, 187: 109381.
[21]Liu Y, Zhang H, Wang J, et al. High glucose enhances glycemic variability-induced endothelial cell damage via the AGE-RAGE-oxidative stress pathway [J]. Cell Biochemistry and Function, 2020, 38(7): 463-470.
[22]Wang L, Li H, Zhang Y, et al. Fasting blood glucose and the risk of deep vein thrombosis after total hip arthroplasty in patients with type 2 diabetes mellitus [J]. Journal of Orthopaedic Surgery and Research, 2021, 16(1): 589.
[23]Li J, Chen Y, Liu J, et al. Glycemic variability is associated with deep vein thrombosis after total knee arthroplasty in diabetic patients [J]. Clinical Orthopaedics and Related Research, 2022, 480(10): 2214-2223.
[24]Zhang Y, Wang X, Li Z, et al. Glycemic variability and myocardial infarction after coronary artery bypass grafting in diabetic patients [J]. Journal of Cardiothoracic and Vascular Anesthesia, 2020, 34(10): 2820-2826.
[25] Chinese Society of Endocrinology and Metabolism, Chinese Society of Anesthesiology. Expert Consensus on Perioperative Glycemic Management in Diabetic Patients (2017 Edition) [J]. Chinese Journal of Diabetes Mellitus, 2017, 9 (5): 275-282.
[2]Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism in orthopedic surgery patients: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) [J]. Chest, 2008, 133(6 Suppl): 381S-453S.
[3]Chinese Orthopaedic Association, Chinese Trauma Association. China Guidelines for the Prevention of Venous Thromboembolism in Major Orthopedic Surgery (2021 Edition) [J]. Chinese Journal of Orthopaedics, 2021, 41 (20): 1321-1330.
[4]American Diabetes Association. Standards of Medical Care in Diabetes — 2023 [J]. Diabetes Care, 2023, 46(Suppl 1): S1-S29.
[5]Monnier L, Colette C. Glucose variability: the third component of the glycemic triad [J]. Diabetes Metab, 2008, 34(5 Suppl 2): S45-S51.
[6]Li H, Zhou J, Jia W. Relationship between glycemic variability and chronic complications of diabetes mellitus [J]. Chinese Journal of Endocrinology and Metabolism, 2012, 28 (9): 709-712.
[7]Zhang X, Li Y, Wang J, et al. Mean amplitude of glycemic excursions is associated with cardiovascular events in patients with type 2 diabetes mellitus [J]. Journal of Clinical Endocrinology & Metabolism, 2018, 103(10): 3869-3876.
[8]Chen Y, Liu J, Zhang H, et al. Glycemic variability and postoperative complications in diabetic patients undergoing total knee arthroplasty [J]. Journal of Orthopaedic Surgery and Research, 2020, 15(1): 456.
[9]Service FJ, Molnar GD, Rosevear JW, et al. Mean amplitude of glycemic excursions, a measure of diabetic instability [J]. Diabetes, 1970, 19(11): 644-655.
[10]Zhou J, Yu M, Jia W, et al. Evaluation of intraday and interday glycemic variability in patients with type 2 diabetes mellitus by continuous glucose monitoring [J]. Chinese Journal of Endocrinology and Metabolism, 2006, 22 (3): 286-288.
[11]Chinese Orthopaedic Association. China Guidelines for the Prevention of Venous Thromboembolism in Major Orthopedic Surgery (2021 Edition) [J]. Chinese Journal of Orthopaedics, 2021, 41 (20): 1321-1330.
[12]Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018) [J]. Circulation, 2018, 138(20): e618-e651.
[13]Brownlee M. Biochemistry and molecular cell biology of diabetic complications [J]. Nature, 2001, 414(6865): 813-820.
[14]Ceriello A. The possible role of glycemic variability in the development of microvascular complications in type 2 diabetes mellitus [J]. Diabetes Care, 2005, 28(11): 2754-2755.
[15]Zhang L, Wang Y, Li X, et al. Glycemic variability induces endothelial dysfunction via oxidative stress-mediated activation of the NF-κB pathway in type 2 diabetes [J]. Experimental and Therapeutic Medicine, 2022, 24(3): 168.
[16]Marfella R, Portoghese M, Paolisso G. Glucose variability and cardiovascular complications in diabetes mellitus [J]. World Journal of Diabetes, 2015, 6(11): 1291-1298.
[17]Fonseca VA, Burcin M, Bell D, et al. Glycemic variability and cardiovascular outcomes in type 2 diabetes: a post hoc analysis of the EXAMINE trial [J]. Diabetes Care, 2017, 40(8): 1031-1037.
[18]Wang X, Li J, Yang L, et al. Glycemic variability exacerbates myocardial ischemia-reperfusion injury by activating the NLRP3 inflammasome in diabetic rats [J]. International Journal of Molecular Medicine, 2021, 48(3): 163.
[19]Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy [J]. Diabetes Care, 2009, 32(1): 193-203.
[20]Qiu Y, Chen L, Xu X, et al. Interaction between HbA1c and glycemic variability on the risk of microvascular complications in type 2 diabetes [J]. Diabetes Research and Clinical Practice, 2022, 187: 109381.
[21]Liu Y, Zhang H, Wang J, et al. High glucose enhances glycemic variability-induced endothelial cell damage via the AGE-RAGE-oxidative stress pathway [J]. Cell Biochemistry and Function, 2020, 38(7): 463-470.
[22]Wang L, Li H, Zhang Y, et al. Fasting blood glucose and the risk of deep vein thrombosis after total hip arthroplasty in patients with type 2 diabetes mellitus [J]. Journal of Orthopaedic Surgery and Research, 2021, 16(1): 589.
[23]Li J, Chen Y, Liu J, et al. Glycemic variability is associated with deep vein thrombosis after total knee arthroplasty in diabetic patients [J]. Clinical Orthopaedics and Related Research, 2022, 480(10): 2214-2223.
[24]Zhang Y, Wang X, Li Z, et al. Glycemic variability and myocardial infarction after coronary artery bypass grafting in diabetic patients [J]. Journal of Cardiothoracic and Vascular Anesthesia, 2020, 34(10): 2820-2826.
[25] Chinese Society of Endocrinology and Metabolism, Chinese Society of Anesthesiology. Expert Consensus on Perioperative Glycemic Management in Diabetic Patients (2017 Edition) [J]. Chinese Journal of Diabetes Mellitus, 2017, 9 (5): 275-282.
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