• Vivek K Moitra, Jason Greenberg, Srikesh Arunajadai, and BobbieJean Sweitzer.
• Department of Anesthesiology and Critical Care, University of Chicago, Chicago, IL, USA. vm2161@columbia.edu
• Can J Anaesth. 2010 Apr 1; 57 (4): 322329322-9.

PurposeHyperglycemia and elevated glycosylated hemoglobin (HbA(1c)) are associated with perioperative morbidity in patients with diabetes, but the relationship between long-term glycemic control and perioperative glucose control is unknown. The purpose of this study was to determine the relationship between glycosylated hemoglobin (HbA(1c)) and perioperative glucose in fasting patients with type 2 diabetes undergoing elective non-cardiac surgery.MethodsThis was a prospective observational study of 244 adult patients with type 2 diabetes who were evaluated before elective non-cardiac surgery at a preoperative medicine clinic in a tertiary care medical centre during the period September 2004 to May 2005. Preoperative HbA(1c) levels were determined, and preoperative and postoperative glucose values were measured on the day of surgery. The primary outcome variables were preoperative and postoperative blood glucose values.ResultsHalf of all study patients had an HbA(1c) > or = 7%, including 23% of patients with HbA(1c) >/= 8%. HbA(1c) levels predict preoperative glucose levels, and preoperative glucose levels and duration of surgery predict postoperative glucose levels. Glucose levels in one-third of the patients with type 2 diabetes decreased during surgery without administration of insulin or glucose-regulating medications.ConclusionHbA(1c) values may serve as biomarkers for glucose control during the immediate perioperative period in patients with type 2 diabetes undergoing elective surgery.

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