LETTERS TO THE EDITOR
REVISTA DE LA FACULTAD DE MEDICINA HUMANA 2019 - Universidad Ricardo Palma
1 Ricardo Palma University. Lima, Peru.
2 Student of the Faculty of Human Medicine.
Mr. Editor
Type 2 diabetes mellitus is a public health problem in Peru and in the world. According to the International
Diabetes Federation, it is estimated that there are 387 million people in the world with DM-2. According to
national studies, the prevalence of DM-2 in Peru is between 4, 1% and 8, 4%. The main chronic complication
of DM-2, both because of its frequency and the consequent disability it generates, is the diabetic foot. Thus,
15% of diabetic patients will develop foot injuries. Most of them will suffer a successful epithelialization of
their ulcers but between 15% and 20%, will suffer amputations of the lower limb(1).
In this regard, it is known that patients with diabetes mellitus have a high risk of postoperative complications,
including infections, inadequate wound healing, cardiovascular events, venous thromboembolism , and
mortality. Due to the fact that average hyperglycemia has been thought to be risky, it is usually recommended
to optimize glycemic control, in cases of elective surgery(2)
Poor glycemic control, indicated by elevated levels of glycosylated hemoglobin (HbA1c), could be associated
with an increased risk of postoperative complications. There are different studies that have evaluated the
effect of HbA1c levels on the development of surgical site infections, proposing a cause and effect relationship
between them.
Our objective was to review the evidence regarding the effect of HbA1c on the development of post-surgical
infection in patients with diabetic foot.
The electronic search of various scientific articles related to the subject was carried out. The search sources
were PubMed, Scielo, BVS, Google Scholar and the Ricardo Palma University Repository. The keywords were:
"glycosylated hemoglobin", "Diabetic foot infection", "infectious complication" and "Amputee diabetic foot",
"glycosylated hemoglobin", "diabetic foot amputee infection", "markers of diabetic foot infection" .
We found 5 articles that evaluate this association (table N°1), all of them retrospective in nature, in 4 of them a
significant statistical association was found, with OR that fluctuated between 3.94 and 1.05, while in 1 of them
it was not found significant association between both factors.
Although most studies find a statistically significant association between high levels
of preoperative glycosylated hemoglobin and the development of postoperative
infections, the quality of evidence may be questionable, by retrospective
nature. On the other hand, having not found national studies, no solid conclusions
can be made for our population, for this reason it is proposed to carry out the same
that reflect the national problematic. If the relationship is verified, patients with
increased levels of preoperative glycosylated hemoglobin should be properly
evaluated and continuously monitor the evolution of the wound by a
multidisciplinary team, in order to avoid complications.
Table 1. General characteristics of the selected articles.
|
AUTHOR YEAR |
SAMPLE SIZE | STUDY DESIGN | RESULTS |
|
Domek (2) 2016 |
21854 patients | Retrospective observational case series study | The value of HbA1c who developed infection averaged 6. 41%, compared than 6.11% for those who did not develop infection (OR 1. 05 95% P = 0. 015) |
|
Cancienne (3) 2017 |
7736 patients | Baseline analysis of a series of cases | Patients with an HbA1c level of 7.5% or more had a significantly higher risk of infection compared to patients below this threshold (OR, 2. 6; 95% CI, 1.9- 3.4; P < 0, 0001) |
|
Muñoz (4) 2003 |
740 patients |
Study of historical cohorts |
There is no correlation between the degree of glycemic control (HbA1c%) with the frequency of infections in diabetic patients studied (p = 0.33) |
|
Jupiter (5) 2014 |
322 patients |
Retrospective observational study of a database |
The infection rate increased steadily as HbA1c increased to 7.3%. and then slowly until HbA1c reached 8% to 8.5%, while it increased dramatically when HbA1c reached levels of 10% (OR 3.94 95% CI: 2.38 to 6.61) |
|
Humphers (6) 2014 |
322 patients |
Retrospective Cohort Study |
HbA1c was significantly associated with postoperative infections. With each 1% increase in HbA1c increases the chances of infection by a factor of 1.59 and complications in wound healing (OR = 1. 25, 95% CI = 1.02- 1.53) |
Authorship Contributions: The authors participated
in the conception, collection of information, writing
and approval of the final version of the article.
Financing: Self-financed
Interest conflict: The authors declare no conflicts of
interest in the publication of this article.
Received: November 15, 2019
Approved: December 26, 2019
