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Diabetes: Symptoms, Diagnosis, and Complications01:15

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For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
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Diabetes: Management and Pharmacotherapy01:15

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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A thorough health history and physical assessment are essential for identifying cardiovascular disease (CVD) symptoms and distinguishing them from other health issues.
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Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia. The four categories of diabetes are type 1 diabetes, type 2 diabetes, other specific types of diabetes, and gestational diabetes.
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Diabetes Status and Cardiovascular Complications Risk in Noncardiac Surgery: A Population-Based Cohort Study.

Yunxi Ji1, Zhihan Lyu2, Bin Cui1

  • 1Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
|February 27, 2025
PubMed
Summary

Patients with prediabetes or undiagnosed diabetes undergoing noncardiac surgery face higher risks of major adverse cardiovascular events (MACE). This highlights the importance of glycemic status assessment in surgical risk stratification.

Keywords:
cohort studycomplicationsdiabetes mellitusmajor adverse cardiovascular eventsperioperative medicine

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Area of Science:

  • Cardiology
  • Endocrinology
  • Perioperative Medicine

Background:

  • Diabetes mellitus is a known risk factor for cardiovascular complications in surgical patients.
  • Limited data exists on cardiovascular risks associated with prediabetes and undiagnosed diabetes in noncardiac surgery.
  • Glycemic control is crucial for managing surgical outcomes.

Purpose of the Study:

  • To investigate the association between different glycated hemoglobin levels (prediabetes, undiagnosed diabetes, diagnosed diabetes) and postoperative cardiovascular risks.
  • To assess the incidence of major adverse cardiovascular events (MACE) in patients undergoing noncardiac surgery based on glycemic status.
  • To identify specific patient subgroups at higher risk for MACE.

Main Methods:

  • Population-based cohort study including 13,207 patients undergoing noncardiac surgery.
  • Patients categorized into four groups: nondiabetes, prediabetes, undiagnosed diabetes, and diagnosed diabetes.
  • Primary endpoint: 30-day postoperative MACE. Secondary endpoint: 90-day postoperative MACE. Analyzed using Cox proportional hazards models and Kaplan-Meier curves.

Main Results:

  • A significant proportion of patients had prediabetes (29.08%) or undiagnosed diabetes (11.52%).
  • Prediabetes (HR 1.70), undiagnosed diabetes (HR 2.36), and diagnosed diabetes (HR 2.33) were associated with increased 30-day MACE risk compared to nondiabetes.
  • Similar increased risks observed at 90 days, with a significant interaction between sex and glycemic status.

Conclusions:

  • A substantial number of patients undergoing noncardiac surgery have prediabetes or undiagnosed diabetes.
  • These glycemic states are independently associated with a significantly increased risk of postoperative major adverse cardiovascular events.
  • Glycemic status is a critical factor in perioperative cardiovascular risk assessment for noncardiac surgery.