Incidence and risk factors for poor perioperative blood glucose management in patients with diabetic foot: a retrospective study.

Abstract

Diabetic foot (DF) is one of the most serious complications of diabetes mellitus (DM). In some cases of DF, life-saving amputation is necessary. This study set out to investigate the situation of preoperative blood glucose management in patients with DF. A retrospective study was performed in two centers between January 2015 and June 2018. Adult patients who received surgical treatment for DF, including amputation, debridement, and flap or skin graft, were included. Demographic and clinical data of the patients were collected. All patients were followed up for at least 3 years, until June 2021. The study outcomes included postoperative mortality, and the incidences of postoperative renal impairment, surgical infection, complete wound closure within 3 months, and reamputation. Univariable and multivariable logistic regression analyses were performed to determine the risk factors for adverse outcomes and poor blood glucose management. Kaplan-Meier curves were generated to compare survival between patients with different preoperative levels of blood glucose. This study included 268 patients with DF, who were divided into four groups: normal (n=72), hyperglycemia (n=95), hypoglycemia (n=44), and mixed (n=57). Total mortality was much higher in the hyperglycemia, hypoglycemia, and mixed groups than in the normal group (P=0.030, 0.009, and 0.014, respectively). The incidences of surgical infection, complete wound closure within 3 months, and reamputation were significantly higher in the hyperglycemia, hypoglycemia, and mixed groups than in the normal group. Older age and a longer duration of DM were confirmed to be important risk factors for hyperglycemia, hypoglycemia, and mixed hyperglycemia and hypoglycemia. Having higher levels of glycosylated hemoglobin (HbA1c) and creatinine and a lower level of albumin was identified as a risk factor for hyperglycemia, hypoglycemia, or mixed hyperglycemia and hypoglycemia. This study emphasizes the importance of perioperative blood glucose management for patients with DF and provides a basis for blood glucose management of these patients in the future.