title: Effect of the systemic inflammatory response, as provoked by elective orthopaedic surgery, on HbA1c.
abstract: Background In acutely ill patients with new onset hyperglycaemia, plasma glucose cannot reliably distinguish between stress hyperglycaemia and undiagnosed diabetes mellitus. We, therefore, investigated the diagnostic reliability of glycated haemoglobin (HbA1c) in acute illness by prospectively evaluating the effect of the systemic inflammatory response, as provoked by elective orthopaedic surgery, on HbA1c. Methods HbA1cand serum C-reactive protein concentrations were compared before and two days after elective knee or hip surgery in 30 patients without diabetes. C-reactive protein was used to assess the systemic inflammatory response. Results The mean (standard deviation) serum C-reactive protein increased following surgery (4.8 [7.5] vs. 179.7 [61.9] mg/L; P<0.0001). HbA1cwas similar before and after surgery (39.2 [5.4] vs. 38.1 [5.1] mmol/moL, respectively; P = 0.4363). Conclusions HbA1cis unaffected within two days of a systemic inflammatory response as provoked by elective orthopaedic surgery. This suggests that HbA1cmay be able to differentiate newly presenting type 2 diabetes mellitus from stress hyperglycaemia in acutely ill patients with new onset hyperglycaemia.
authors.affiliation: 1 Clinical Chemistry, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Chadburn
authors.affiliation: 1 Clinical Chemistry, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Garman
authors.affiliation: 2 Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
authors.forename: Raad
authors.initials: R
authors.lastname: Abbas
authors.affiliation: 1 Clinical Chemistry, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
authors.forename: Anu
authors.initials: A
authors.lastname: Modupe
authors.affiliation: 1 Clinical Chemistry, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Ford
authors.affiliation: 2 Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
authors.forename: Osmond L
authors.initials: OL
authors.lastname: Thomas
authors.affiliation: 2 Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Chugh
authors.affiliation: 2 Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
authors.forename: Shreeram
authors.initials: S
authors.lastname: Deshpande
authors.affiliation: 1 Clinical Chemistry, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.|3 Research Institute, Healthcare Sciences, Wolverhampton University, Wolverhampton, UK.
authors.forename: Rousseau
authors.initials: R
authors.lastname: Gama
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000523:psychology*; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D003937:Diagnosis, Differential; D017558:Elective Surgical Procedures / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis*; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013315:Stress, Psychological / Q000097:blood / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: HbA1c; Systemic inflammatory response; acute illness