Prevalence of Undiagnosed Diabetes and Prediabetes and the Association with Postoperative Hyperglycemia and Increased Health Care Cost

Introduction: Undiagnosed type 2 diabetes (T2D) and prediabetes (PD) are associated with postoperative hyperglycemia (POHG) and prevalent in high-income countries and urban areas of low- to middle-income countries. What is not known, is the prevalence of T2D and PD in patients undergoing elective operations in rural areas of low- to middle-income countries, or their consequences for POHG and outcomes of operation. Method(s): We prospectively enrolled patients without known T2D/PD undergoing routine elective surgical procedures in a rural district hospital in the eastern region of Ghana. Preoperative fasting blood glucose, postoperative blood glucose, and surgical outcomes were recorded. Logistic regression analysis was invoked to delineate independent predictors of POHG and length of stay (LOS) >=2 days. Result(s): Of 92 patients, 41% were male, mean age was 47 +/- 14 years. Based on preoperative fasting blood glucose, 11% of patients met criteria for undiagnosed T2D and 60% for undiagnosed PD. A total of 32% of patients developed POHG and 54% developed prolonged LOS. Univariate analysis revealed impaired fasting blood glucose was associated with POHG. Those who were diabetic had the highest prevalence of POHG, followed by PD and nondiabetics (p = 0.0212). Multivariable analysis showed that POHG (odds ratio 5.1; 95% CI 1.6 to 16.3) and sex (odds ratio 8.9; 95% CI 3.0 to 26.1) were associated with prolonged length of stay. Conclusion(s): Among these elective surgical patients, undiagnosed T2D and PD were prevalent, leading to POHG and associated increases in use of resources. Our observations suggest that routine operations might be used as opportunities to screen for T2D and PD, thereby improving outcomes after operation and providing early recognition of diabetes and its long-term health burdens.Copyright © 2019