Continuation of Oral Antidiabetic Medications Was Associated With Better Early Postoperative Blood Glucose Control Compared to Sliding Scale Insulin After Total Knee Arthroplasty

Justin Leal; Samuel S Wellman; William A Jiranek; Thorsten M Seyler; Michael P Bolognesi; Sean P Ryan

doi:10.1016/j.arth.2024.02.069

Continuation of Oral Antidiabetic Medications Was Associated With Better Early Postoperative Blood Glucose Control Compared to Sliding Scale Insulin After Total Knee Arthroplasty

J Arthroplasty. 2024 Feb 28:S0883-5403(24)00189-X. doi: 10.1016/j.arth.2024.02.069. Online ahead of print.

Authors

Justin Leal¹, Samuel S Wellman¹, William A Jiranek¹, Thorsten M Seyler¹, Michael P Bolognesi¹, Sean P Ryan¹

Affiliation

¹ Department of Orthopaedic Surgery, Duke University, Durham, North Carolina.

PMID: 38428690
DOI: 10.1016/j.arth.2024.02.069

Abstract

Background: This study evaluated blood glucose (BG), creatinine levels, metabolic issues, length of stay (LOS), and early postoperative complications in diabetic primary total knee arthroplasty (TKA) patients. It examined those who continued home oral antidiabetic medications and those who switched to insulin postoperatively. The hypothesis was that continuing home medications would lead to lower BG levels without metabolic abnormalities.

Methods: Patients who had diabetes who underwent primary TKA from 2013 to 2022 were evaluated retrospectively. Diabetic patients who were not on home oral antidiabetic medications or who were not managed as an inpatient postoperatively were excluded. Patient demographics and laboratory tests collected preoperatively and postoperatively as well as 90-day emergency department visits and 90-day readmissions, were pulled from electronic records. Patients were grouped based on inpatient diabetes management: continuation of home medications versus new insulin coverage. Acute postoperative BG control, creatinine levels, metabolic abnormalities, LOS, and early postoperative complications were compared between groups. Multivariable regression analyses were performed to measure associations.

Results: A total of 867 primary TKAs were assessed; 703 (81.1%) patients continued their home oral antidiabetic medications. Continuing home antidiabetic medications demonstrated lower median maximum inpatient BG (180.0 mg/dL versus 250.0 mg/dL; P < .001) and median average inpatient BG (136.7 mg/dL versus 173.7 mg/dL; P < .001). Logistic regression analyses supported the presence of an association (odds ratio = 17.88 [8.66, 43.43]; P < .001). Proportions of acute kidney injury (13.5 versus 26.7%; P < .001) were also lower. There was no difference in relative proportions of metabolic acidosis (4.4 versus 3.7%; P = .831), LOS (2.0 versus 2.0 days; P = .259), or early postoperative complications.

Conclusions: Continuing home oral antidiabetic medications after primary TKA was associated with lower BG levels without an associated worsening creatinine or increase in metabolic acidosis.

Level iii evidence: Retrospective Cohort Study.

Keywords: blood glucose control; inpatient diabetes management; oral antidiabetic medications; total knee arthroplasty (TKA); type II diabetes mellitus.