ArticleArchives of orthopaedic and trauma surgery2025
Anti-diabetic medications' effect on outcomes and glycemic markers following TJA in patients with type 2 diabetes.
Article in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionDiabetes is a known risk factor for surgical-site infection (SSI) following total joint arthroplasty (TJA), but the impact of antidiabetic medications on outcomes remains unclear. This study investigated the association between medication regimen, clinical outcomes, and glycemic control in patients with Type 2 diabetes (T2DM).
methodsWe retrospectively reviewed T2DM patients undergoing primary, elective TJA from 2011 to 2022. Patients were stratified by their antidiabetic medication regimen taken for at least one month in the year preoperatively: (1) one medication, (2) 2 + medications, and (3) insulin-containing regimen. Cohorts were matched by preoperative hemoglobin A1c (HbA1c), age, body-mass index (BMI), sex, and ASA class. Demographics, outcomes, and glycemic markers were compared.
resultsOf 2767 TJAs, 55.4%, 30.1%, and 14.5% fell into Cohorts 1, 2, and 3, respectively. After matching, each cohort included 273 procedures. Insulin-treated patients had greater blood glucose variability during hospitalization (153.7 vs. 114.8 [1] & 119.0 [2]; P < 0.001). Long-term outcomes, revision incidence, and SSIs did not differ significantly across cohorts. In regression of the pre-match population, insulin-containing regimens (OR: 2.8; P = 0.015), higher BMI (OR: 1.1; P = 0.002), and elevated preoperative HbA1c (OR: 1.3; P = 0.049) predicted SSI following THA. No significant predictors of SSI after TKA were found, and medication regimen was not associated with revision risk.
conclusionPatients with T2DM on insulin-containing regimens exhibited worse perioperative glycemic control and increased SSI incidence after THA, although medication regimen did not affect outcomes after TKA. Our findings are the first to suggest that insulin requirements in patients with T2DM, independent of glycemic control measured with preoperative HbA1c, may influence infection risk following THA and complicate perioperative glycemic control after TJA. We emphasize the importance of perioperative optimization and proactive management of these higher-risk patients, regardless of their preoperative HbA1c.
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