Inadequate pre-operative glycaemic control in patients with diabetes mellitus adversely influences functional recovery after total knee arthroplasty: Patients with impaired glycaemic control exhibit poorer functional outcomes at 1-year post-arthroplasty
Purpose Whilst inadequate glycaemic control is associated with an increase in perioperative complications following total knee arthroplasty, the impact of glycaemic control in this at-risk patient group remains ill-defined. Identification of at-risk patients would allow targeted pre-operative glycae...
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Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2017-06, Vol.25 (6), p.1801-1806 |
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container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
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creator | Brock, Timothy M. Shirley, Mark Bardgett, Michelle Walker, Mark Deehan, David J. |
description | Purpose
Whilst inadequate glycaemic control is associated with an increase in perioperative complications following total knee arthroplasty, the impact of glycaemic control in this at-risk patient group remains ill-defined. Identification of at-risk patients would allow targeted pre-operative glycaemic control intervention.
Methods
One hundred consecutive patients with a diagnosis of diabetes mellitus and one hundred age, sex and BMI matched patients without diabetes undergoing total knee arthroplasty in a single institution were analysed between 2008 and 2013. Inadequate glycaemic control was defined as having an HbA1c of greater than 64 mmol/mol (8.0 % NGSP) measured within the 3 months before surgery. Patient demographics, diabetes management and complications of diabetes were recorded and used as explanatory variables to deliver a generalised linear model. This allows for relationships to be defined between change in patient-reported function (SF-36, WOMAC) and these explanatory variables.
Results
The patient group with concomitant diabetes exhibited smaller improvements in WOMAC and SF-36 physical component summary at 1 year after knee arthroplasty. This effect was most pronounced in the subset of patients with inadequate glycaemic control recorded in the early pre-operative period.
Conclusion
Patients with diabetes, particularly those with inadequate glycaemic control, exhibit less improvement at 1 year following knee arthroplasty than patients without diabetes mellitus. Clinical focus on modulating this factor in this at-risk group is warranted.
Level of evidence
III. |
doi_str_mv | 10.1007/s00167-016-4249-0 |
format | Article |
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Whilst inadequate glycaemic control is associated with an increase in perioperative complications following total knee arthroplasty, the impact of glycaemic control in this at-risk patient group remains ill-defined. Identification of at-risk patients would allow targeted pre-operative glycaemic control intervention.
Methods
One hundred consecutive patients with a diagnosis of diabetes mellitus and one hundred age, sex and BMI matched patients without diabetes undergoing total knee arthroplasty in a single institution were analysed between 2008 and 2013. Inadequate glycaemic control was defined as having an HbA1c of greater than 64 mmol/mol (8.0 % NGSP) measured within the 3 months before surgery. Patient demographics, diabetes management and complications of diabetes were recorded and used as explanatory variables to deliver a generalised linear model. This allows for relationships to be defined between change in patient-reported function (SF-36, WOMAC) and these explanatory variables.
Results
The patient group with concomitant diabetes exhibited smaller improvements in WOMAC and SF-36 physical component summary at 1 year after knee arthroplasty. This effect was most pronounced in the subset of patients with inadequate glycaemic control recorded in the early pre-operative period.
Conclusion
Patients with diabetes, particularly those with inadequate glycaemic control, exhibit less improvement at 1 year following knee arthroplasty than patients without diabetes mellitus. Clinical focus on modulating this factor in this at-risk group is warranted.
Level of evidence
III.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-016-4249-0</identifier><identifier>PMID: 27502788</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Aged, 80 and over ; Arthroplasty (knee) ; Arthroplasty, Replacement, Knee - adverse effects ; Biomedical materials ; Blood Glucose - metabolism ; Body mass ; Complications ; Demographics ; Demography ; Diabetes ; Diabetes Complications ; Diabetes mellitus ; Diabetes Mellitus - blood ; Female ; Glycated Hemoglobin A - analysis ; Group therapy ; Humans ; Intervention ; Joint surgery ; Knee ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Orthopedics ; Patients ; Postoperative Complications ; Recovery (Medical) ; Recovery of Function ; Retrospective Studies ; Risk factors ; Risk management ; Surgery ; Surgical implants</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2017-06, Vol.25 (6), p.1801-1806</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016</rights><rights>Knee Surgery, Sports Traumatology, Arthroscopy is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2390-9d5edf90c02db1a8f0d50f247ebdb9a3e62701b8c83530e55afbdabab580bda43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-016-4249-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-016-4249-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27926,27927,41490,42559,51321</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27502788$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brock, Timothy M.</creatorcontrib><creatorcontrib>Shirley, Mark</creatorcontrib><creatorcontrib>Bardgett, Michelle</creatorcontrib><creatorcontrib>Walker, Mark</creatorcontrib><creatorcontrib>Deehan, David J.</creatorcontrib><title>Inadequate pre-operative glycaemic control in patients with diabetes mellitus adversely influences functional recovery after total knee arthroplasty: Patients with impaired glycaemic control exhibit poorer functional outcomes at 1-year post-arthroplasty</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
Whilst inadequate glycaemic control is associated with an increase in perioperative complications following total knee arthroplasty, the impact of glycaemic control in this at-risk patient group remains ill-defined. Identification of at-risk patients would allow targeted pre-operative glycaemic control intervention.
Methods
One hundred consecutive patients with a diagnosis of diabetes mellitus and one hundred age, sex and BMI matched patients without diabetes undergoing total knee arthroplasty in a single institution were analysed between 2008 and 2013. Inadequate glycaemic control was defined as having an HbA1c of greater than 64 mmol/mol (8.0 % NGSP) measured within the 3 months before surgery. Patient demographics, diabetes management and complications of diabetes were recorded and used as explanatory variables to deliver a generalised linear model. This allows for relationships to be defined between change in patient-reported function (SF-36, WOMAC) and these explanatory variables.
Results
The patient group with concomitant diabetes exhibited smaller improvements in WOMAC and SF-36 physical component summary at 1 year after knee arthroplasty. This effect was most pronounced in the subset of patients with inadequate glycaemic control recorded in the early pre-operative period.
Conclusion
Patients with diabetes, particularly those with inadequate glycaemic control, exhibit less improvement at 1 year following knee arthroplasty than patients without diabetes mellitus. Clinical focus on modulating this factor in this at-risk group is warranted.
Level of evidence
III.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arthroplasty (knee)</subject><subject>Arthroplasty, Replacement, Knee - adverse effects</subject><subject>Biomedical materials</subject><subject>Blood Glucose - metabolism</subject><subject>Body mass</subject><subject>Complications</subject><subject>Demographics</subject><subject>Demography</subject><subject>Diabetes</subject><subject>Diabetes Complications</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - blood</subject><subject>Female</subject><subject>Glycated Hemoglobin A - analysis</subject><subject>Group therapy</subject><subject>Humans</subject><subject>Intervention</subject><subject>Joint surgery</subject><subject>Knee</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Patients</subject><subject>Postoperative Complications</subject><subject>Recovery (Medical)</subject><subject>Recovery of Function</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Risk management</subject><subject>Surgery</subject><subject>Surgical implants</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kc1u1TAQhS0EopfCA7BBltiwCYztOI6XqOKnUiU2sI78M2lTEju1naK8Bw-Mr25BCInNeOTzzRmNDiEvGbxlAOpdBmCdamppWt7qBh6RA2uFaJRo1WNyAN3yhoPszsiznG8Batvqp-SMKwlc9f2B_LwMxuPdZgrSNWETV0ymTPdIr-fdGVwmR10MJcWZToGuVcNQMv0xlRvqJ2OxYKYLzvNUtkyNv8eUcd4rPM4bBlfVcQuuTDGYmSZ0sRI7NWPBREss9fN7QKQmlZsU19nksj8nT0YzZ3zx8J6Tbx8_fL343Fx9-XR58f6qcVxoaLSX6EcNDri3zPQjeAkjbxVab7UR2HEFzPauF1IASmlG6401VvZQm1ackzcn3zXFuw1zGZYpu3qLCRi3PLBeasWk0kf09T_obdxSPalSGqTo267jlWInyqWYc8JxWNO0mLQPDIZjZMMpsqGW4RjZAHXm1YPzZhf0fyZ-Z1QBfgJylcI1pr9W_9f1F-hOpiE</recordid><startdate>20170601</startdate><enddate>20170601</enddate><creator>Brock, Timothy M.</creator><creator>Shirley, Mark</creator><creator>Bardgett, Michelle</creator><creator>Walker, Mark</creator><creator>Deehan, David J.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20170601</creationdate><title>Inadequate pre-operative glycaemic control in patients with diabetes mellitus adversely influences functional recovery after total knee arthroplasty</title><author>Brock, Timothy M. ; Shirley, Mark ; Bardgett, Michelle ; Walker, Mark ; Deehan, David J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2390-9d5edf90c02db1a8f0d50f247ebdb9a3e62701b8c83530e55afbdabab580bda43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arthroplasty (knee)</topic><topic>Arthroplasty, Replacement, Knee - adverse effects</topic><topic>Biomedical materials</topic><topic>Blood Glucose - metabolism</topic><topic>Body mass</topic><topic>Complications</topic><topic>Demographics</topic><topic>Demography</topic><topic>Diabetes</topic><topic>Diabetes Complications</topic><topic>Diabetes mellitus</topic><topic>Diabetes Mellitus - blood</topic><topic>Female</topic><topic>Glycated Hemoglobin A - analysis</topic><topic>Group therapy</topic><topic>Humans</topic><topic>Intervention</topic><topic>Joint surgery</topic><topic>Knee</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Patients</topic><topic>Postoperative Complications</topic><topic>Recovery (Medical)</topic><topic>Recovery of Function</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Risk management</topic><topic>Surgery</topic><topic>Surgical implants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brock, Timothy M.</creatorcontrib><creatorcontrib>Shirley, Mark</creatorcontrib><creatorcontrib>Bardgett, Michelle</creatorcontrib><creatorcontrib>Walker, Mark</creatorcontrib><creatorcontrib>Deehan, David J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brock, Timothy M.</au><au>Shirley, Mark</au><au>Bardgett, Michelle</au><au>Walker, Mark</au><au>Deehan, David J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inadequate pre-operative glycaemic control in patients with diabetes mellitus adversely influences functional recovery after total knee arthroplasty: Patients with impaired glycaemic control exhibit poorer functional outcomes at 1-year post-arthroplasty</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2017-06-01</date><risdate>2017</risdate><volume>25</volume><issue>6</issue><spage>1801</spage><epage>1806</epage><pages>1801-1806</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
Whilst inadequate glycaemic control is associated with an increase in perioperative complications following total knee arthroplasty, the impact of glycaemic control in this at-risk patient group remains ill-defined. Identification of at-risk patients would allow targeted pre-operative glycaemic control intervention.
Methods
One hundred consecutive patients with a diagnosis of diabetes mellitus and one hundred age, sex and BMI matched patients without diabetes undergoing total knee arthroplasty in a single institution were analysed between 2008 and 2013. Inadequate glycaemic control was defined as having an HbA1c of greater than 64 mmol/mol (8.0 % NGSP) measured within the 3 months before surgery. Patient demographics, diabetes management and complications of diabetes were recorded and used as explanatory variables to deliver a generalised linear model. This allows for relationships to be defined between change in patient-reported function (SF-36, WOMAC) and these explanatory variables.
Results
The patient group with concomitant diabetes exhibited smaller improvements in WOMAC and SF-36 physical component summary at 1 year after knee arthroplasty. This effect was most pronounced in the subset of patients with inadequate glycaemic control recorded in the early pre-operative period.
Conclusion
Patients with diabetes, particularly those with inadequate glycaemic control, exhibit less improvement at 1 year following knee arthroplasty than patients without diabetes mellitus. Clinical focus on modulating this factor in this at-risk group is warranted.
Level of evidence
III.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>27502788</pmid><doi>10.1007/s00167-016-4249-0</doi><tpages>6</tpages></addata></record> |
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source | MEDLINE; SpringerNature Journals; Access via Wiley Online Library |
subjects | Aged Aged, 80 and over Arthroplasty (knee) Arthroplasty, Replacement, Knee - adverse effects Biomedical materials Blood Glucose - metabolism Body mass Complications Demographics Demography Diabetes Diabetes Complications Diabetes mellitus Diabetes Mellitus - blood Female Glycated Hemoglobin A - analysis Group therapy Humans Intervention Joint surgery Knee Male Medicine Medicine & Public Health Middle Aged Orthopedics Patients Postoperative Complications Recovery (Medical) Recovery of Function Retrospective Studies Risk factors Risk management Surgery Surgical implants |
title | Inadequate pre-operative glycaemic control in patients with diabetes mellitus adversely influences functional recovery after total knee arthroplasty: Patients with impaired glycaemic control exhibit poorer functional outcomes at 1-year post-arthroplasty |
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