Association of a novel glycemic control index, time in range, with infectious complications after pancreatectomy

Time in range (TIR) reflects glycemic variability and is a widely used index for glycemic control in patients with diabetes; however, it is unclear whether it is associated with infectious complications after pancreatectomy. Herein, we examine the association between TIR and infectious complications after pancreatectomy.

This retrospective cohort study collected cases from two different institutions, with one institution providing the discovery cohort (n=543) and the other institution providing the validation cohort (n=540). In total, 1,083 patients who underwent pancreatectomy were included. TIR was defined as the percentage calculated based on a four-point glucose test using the formula: number of times within target range/total number of tests × 100%. The target range was set at 70-150 mg/dL. TIR cutoff value was set to 75% using the receiver operating characteristic curve for the onset of organ/space surgical site infection (SSI).

Of the 543 patients in the discovery cohort, 210 (39%) had TIR ≥75% (well-controlled), and 333 (61%) had TIR <75% (poorly controlled). To balance the clinical characteristics, patients underwent one-by-one propensity score matching, resulting in two groups of 143 patients each. Regarding infection type in the discovery cohort, only organ/space SSI was significantly higher in the poorly controlled group in all patients (19% vs. 27%, P=0.02) and matched patients (20% vs. 35%, P=0.008). TIR <75% was an independent risk factor for organ/space SSI in both cohorts [discovery: odds ratio (OR): 2.13, 95% confidence interval (CI): 1.30-3.50, P=0.003; validation: OR: 1.95, 95% CI: 1.10-3.47, P=0.02].

TIR <75% after pancreatectomy is a risk factor for organ/space SSI. These findings may help provide a new method for glycemic management.