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PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY June 2014 | Archived Issues

The Importance of Glycemic Control for Surgical Candidates

By David Liss, DPM
Chief Resident, Podiatric Medicine and Surgery

Diabetic patients and podiatry have come to develop a very close relationship as nationwide and global rates for the disease continue to rise. Generally, medical management and lifestyle modifications are handled by the primary care physicians, dietitians and diabetic educators. However, it will become increasingly important for all surgical specialties to take an active role in reinforcement of tight glycemic control, especially in their surgical patients.

For a number of reasons, diabetes has long been known to cause increased complication rates after surgery. It has been well documented that uncontrolled diabetes can lead to complications such as peripheral neuropathy, peripheral vascular disease and renal disease. Neuropathy, in particular, causes motor, sensory and autonomic dysfunction, the last of which can cause alterations in microcirculation, regardless of macrovascular status. This results in decreased vasodilation and therefore localized ischemia and poor immune response to surgical sites, which have the potential to become contaminated or infected.

New studies continue to emerge implicating the heightened importance of glycemic control to decrease post-operative infections. A study highlighted in the May edition of the Journal of Bone and Joint Surgery attempted to quantify the increased likelihood of infection for people with diabetes. The study found that diabetics with complications have up to a 7.25-fold increased likelihood of surgical site infection in the lower extremity compared with nondiabetics without neuropathy, and a 3.72-fold increased likelihood when compared to diabetics without complications. Hemoglobin A1C greater than 8 percent was also found to be an independent risk factor.

Studies like these only further bolster the known correlation between uncontrolled diabetes and surgical site infection. With the changes coming to our healthcare system and the increased burden placed on primary care physicians, it will be of utmost importance for not only podiatrists but all surgical specialists to practice preventive medicine and be proactive in better assessing and helping to maintain glycemic control in our patients prior to operating.