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HbA1c predicts long-term postoperative mortality in patients with unknown glycemic status at admission for vascular
Iren D Hjellestad1,2, Eirik Søfteland1,2, Eystein S Husebye1,3
1Department of Laboratory Medicine and Pathology, Hormone Laboratory, Haukeland University Hospital, Bergen, Norway.
Insights
Hemoglobin A1c (HbA1c) may predict long-term mortality in peripheral arterial disease (PAD) patients undergoing surgery. This study found HbA1c useful for preoperative screening of patients with unknown diabetes mellitus status.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Public Health
Background:
- Peripheral arterial disease (PAD) and diabetes mellitus (DM) are significant public health concerns with a strong association.
- Hemoglobin A1c (HbA1c) is the preferred diagnostic tool for type 2 DM.
- Early diagnosis of DM in PAD patients is crucial for risk stratification.
Purpose of the Study:
- To compare the predictive value of HbA1c, fasting plasma glucose (FPG), and 2-hour post-load glucose for mortality in PAD patients.
- To evaluate HbA1c as a predictor of long-term mortality in PAD patients with unknown glycemic status.
Main Methods:
- 273 PAD patients with unknown glycemic status admitted for elective surgery were included.
- Patients underwent HbA1c testing and oral glucose tolerance tests (OGTT).
- Patients were categorized into DM, intermediate hyperglycemia, and normoglycemia groups.
Main Results:
- All-cause mortality was 40% over a 9-year follow-up.
- HbA1c showed a trend towards predicting mortality (HR 1.54, P=0.04) after adjustment for covariates.
- The association between HbA1c and mortality did not reach statistical significance in the fully adjusted model (HR 1.39, P=0.13).
- OGTT was not a significant predictor of long-term mortality.
Conclusions:
- HbA1c can serve as a valuable preoperative screening tool for patients undergoing vascular surgery.
- HbA1c may help identify PAD patients at high risk of long-term mortality.
- Glycemic status assessment is important for risk stratification in PAD patients.
Background:
Peripheral arterial disease (PAD) and diabetes mellitus (DM) represent major public health challenges and are tightly associated. To facilitate early diagnosis, HbA1c has been implemented as the preferred diagnostic tool for the diagnosis of type 2 DM. In this study, we compared and evaluated HbA1c, fasting plasma glucose (FPG), and 2-hour post-load glucose values to determine which test best predicted mortality in patients with PAD.
Methods:
In all, 273 PAD patients with unknown glycemic status admitted to Haukeland University Hospital for elective surgery between October 2006 and September 2007 were included in the study. All 273 patients underwent a standard oral glucose tolerance test (OGTT) in addition to determination of HbA1c; patients were then grouped into those with DM, intermediate hyperglycemia, and normoglycemia according to World Health Organization and International Expert Committee criteria.
Results:
All-cause mortality was 40% over a 9-year follow-up period. After adjusting for age, sex, and relevant medication, HbA1c was a predictor for mortality (hazard ratio [HR] 1.54; 95% confidence interval [CI] 1.03-2.32]; P = 0.04). The association did not achieve statistical significance in a fully adjusted Cox regression model, although the effect estimation of HbA1c on all-cause mortality remained largely unchanged (HR 1.39; 95% CI 0.92-2.09; P = 0.13). The OGTT was not a predictor of long-term mortality.
Conclusions:
The results indicate that HbA1c is a useful marker in the preoperative screening of patients of unknown glycemic status at the time of admission for vascular surgery, and may identify people at high risk of long-term mortality following surgical treatment for PAD.
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