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Exp Clin Endocrinol Diabetes 2021; 129(10): 713-721
DOI: 10.1055/a-1025-3766
Article

Is the Preoperative Glycated Hemoglobin (HbA1c) Level Predictive of the Severity of Diabetic Hand Infection According to Surgical and Clinical Outcomes?

Kaan Gürbüz
1   Department of Orthopedics & Traumatology, Kayseri City Hospital, Kayseri, Turkey
,
Yakup Ekinci
1   Department of Orthopedics & Traumatology, Kayseri City Hospital, Kayseri, Turkey
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Abstract

Objective We purposed to investigate whether preoperative HbA1c level is associated with the severity of surgical treatment in diabetic hand infection cases.

Materials and Methods Between December 2015 and October 2018, 102 patients were surgically treated due to diabetic hand infection. Of the patients, 75 who met the criteria for diabetic hand infection were included in the study. The patients were divided into two groups: Group 1, < 8.5% HbA1c level (poorly controlled); and Group 2, 8.5% or higher HbA1c level (uncontrolled). Preoperative, intraoperative, and postoperative data were recorded. Drainage, VAC, ray/open amputation, and microsurgical reconstruction were performed according to the examination and clinical findings. p<0.05 was considered statistically significant.

Results The study groups consisted of 41 patients (5 female/36 male; median age 59 years, range 32–68) in Group 1 and 34 patients (6 female/28 male; median age 62 years, range 28–67) in Group 2. The mean follow-up period was 21.14±10.42 months in Group 1 and 16.70±10.19 months in Group 2, which were not significantly different (p>0.05). The most common microbiological pathogen was polymicrobial in both study groups (39% in Group 1 and 41.2% in Group 2). Drainage was the most common surgical procedure in both groups and there was no significant difference between the groups in terms of the surgical techniques that were used (p>0.05).

Conclusion Although HbA1c level is an important biomarker for monitoring glycemia in diabetic patients, it is not associated with the severity of surgical treatment in diabetic hand infections.

Key words

diabetes - hand infection - HbA1c, surgical and clinical outcomes


Publikationsverlauf

Eingereicht: 17. Juli 2019
Eingereicht: 31. August 2019

Angenommen: 10. Oktober 2019

Artikel online veröffentlicht:
05. November 2019

© 2019. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Jalil A, Barlaan PI, Fung BKK. et al. Hand infection in diabetic patients. Hand Surg 2011; 16: 307-312
    CrossrefPubMedGoogle Scholar
  • 2 Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet 2003; 361: 1545-1551
    CrossrefPubMedGoogle Scholar
  • 3 Lavery LA, Van Houtum WH, Armstrong DG. et al. Mortality following lower extremity amputation in minorities with diabetes mellitus. Diabetes Res Clin Pract 1997; 37: 41-47
    CrossrefPubMedGoogle Scholar
  • 4 Al-Matubsi HY, Hamdan F, Al Hanbali OA. et al. Diabetic hand syndromes as a clinical and diagnostic tool for diabetes mellitus patients. Diabetes Res Clin Pract 2011; 94: 225-229
    CrossrefPubMedGoogle Scholar
  • 5 Kirazli Y. Rehabilitation of the diabetic hand/Diyabetik el rehabilitasyonu. Turkish J Phys Med Rehabil 2011; 57: 7-11
    PubMedGoogle Scholar
  • 6 Zyluk A, Puchalski P. Hand disorders associated with diabetes: A review. Acta Orthop Belg 2015; 81: 191-196
    PubMedGoogle Scholar
  • 7 Fitzgibbons PG, Weiss A-PC. Hand manifestations of diabetes mellitus. J Hand Surg Am 2008; 33: 771-775
    CrossrefPubMedGoogle Scholar
  • 8 Unachukwu C, Babatunde S, Ihekwaba AE. Diabetes, hand and/or foot ulcers: A cross-sectional hospital-based study in Port Harcourt, Nigeria. Diabetes Res Clin Pract 2007; 75: 148-152
    CrossrefPubMedGoogle Scholar
  • 9 Sharma K, Pan D, Friedman J. et al. Quantifying the effect of diabetes on surgical hand and forearm infections. J Hand Surg Am 2018; 43: 105-114
    CrossrefPubMedGoogle Scholar
  • 10 Benotmane A, Faraoun K, Mohammedi F. et al. Infections of the upper extremity in hospitalized diabetic patients: A prospective study. Diabetes Metab 2004; 30: 91-97
    CrossrefPubMedGoogle Scholar
  • 11 Gill G, Archibald L, Abbas ZG. Diabetic hand infections in the tropics. Diabetes Voice 2003; 48: 17-21
    PubMedGoogle Scholar
  • 12 Li X, Xiao T, Wang Y. et al. Incidence, risk factors for amputation among patients with diabetic foot ulcer in a Chinese tertiary hospital. Diabetes Res Clin Pract 2011; 93: 26-30
    CrossrefPubMedGoogle Scholar
  • 13 Zoberi KA, Salas J, Morgan CN. et al. Comparison of family medicine and general internal medicine on diabetes management. Mol Med 2017; 114: 187-194
    PubMedGoogle Scholar
  • 14 Aragón-Sánchez J, Lázaro-Martínez JL. Impact of perioperative glycaemia and glycated haemoglobin on the outcomes of the surgical treatment of diabetic foot osteomyelitis. Diabetes Res Clin Pract 2011; 94: 83-85
    CrossrefPubMedGoogle Scholar
  • 15 UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837-853
    CrossrefPubMedGoogle Scholar
  • 16 Christman AL, Selvin E, Margolis DJ. et al. Hemoglobin A1c predicts healing rate in diabetic wounds. J Invest Dermatol 2011; 131: 2121-2127
    CrossrefPubMedGoogle Scholar
  • 17 Haneda M, Utsunomiya K, Koya D. et al. A new classification of diabetic nephropathy 2014: A report from Joint Committee on Diabetic Nephropathy. J Diabetes Investig 2015; 6: 242-246
    CrossrefPubMedGoogle Scholar
  • 18 Vella L, Gatt A, Formosa C. Does baseline hemoglobin A1c level predict diabetic foot ulcer outcome or wound healing time?. J Am Podiatr Med Assoc 2017; 107: 272-299
    CrossrefPubMedGoogle Scholar
  • 19 Weintrob AC, Sexton DJ. Susceptibility to infections in persons with diabetes mellitus. Waltham (MA): Up ToDate version 2011
  • 20 Mor A, Berencsi K, Nielsen JS. et al. Rates of community-based antibiotic prescriptions and hospital-treated infections in individuals with and without type 2 diabetes: A Danish Nationwide cohort study, 2004-2012. Clin Infect Dis 2016; 63: 501-511
    CrossrefPubMedGoogle Scholar
  • 21 Hostetter MK. Handicaps to host defense. Effects of hyperglycemia on C3 and Candida albicans. Diabetes 1990; 39: 271-275
    CrossrefPubMedGoogle Scholar
  • 22 Ferguson BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin North Am 2000; 33: 349-365
    CrossrefPubMedGoogle Scholar
  • 23 Aziz KMA. Association between high risk foot, retinopathy and HbA1C in Saudi diabetic population. Pak J Physiol 2010; 6: 22-28
    PubMedGoogle Scholar
  • 24 Parchman ML, Pugh JA, Romero RL. et al. Competing demands or clinical inertia: The case of elevated glycosylated hemoglobin. Ann Fam Med 2007; 5: 196-201
    CrossrefPubMedGoogle Scholar
  • 25 Markuson M, Hanson D, Anderson J. et al. The relationship between hemoglobin A1c values and healing time for lower extremity ulcers in individuals with diabetes. Adv Skin Wound Care 2009; 22: 365-372
    CrossrefPubMedGoogle Scholar
  • 26 Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in diabetes. J Clin Invest 2007; 117: 1219-1222
    CrossrefPubMedGoogle Scholar
  • 27 Malmberg K, Rydén L, Wedel H. et al. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): Effects on mortality and morbidity. Eur Heart J 2005; 26: 650-661
    CrossrefPubMedGoogle Scholar
  • 28 van der Steeg WA, Boekholdt SM, Stein EA. et al. Role of the apolipoprotein B-apolipoprotein A-I ratio in cardiovascular risk assessment: A case-control analysis in EPIC-Norfolk. Ann Intern Med 2007; 146: 640-648
    CrossrefPubMedGoogle Scholar
  • 29 Bahebeck J, Sobgui E, Loic F. et al. Limb-threatening and life-threatening diabetic extremities: clinical patterns and outcomes in 56 patients. J Foot Ankle Surg 2010; 49: 43-46
    CrossrefPubMedGoogle Scholar