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Revista de la Facultad de Medicina Humana

Print version ISSN 1814-5469On-line version ISSN 2308-0531

Rev. Fac. Med. Hum. vol.20 no.1 Lima Jan./Mar. 2020

http://dx.doi.org/10.25176/rfmh.v20i1.2198 

Letters

Glycosilated hemoglobin an allied factor in the prevention of postquirurgical infection of the diabetic foot

Angela Marcela Villanueva-DelBusto1  , Student of the Faculty of Human Medicine

Fiorella Rocío Arce-Huaroto1  , Student of the Faculty of Human Medicine

1Ricardo Palma University. Lima, Peru.

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 limb1.

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 surgery2

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 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)

REFERENCES

1. Ministerio de Salud. Guía técnica: Guía de práctica clínica para el diagnóstico, tratamiento y control del pie diabético. Resolución Minist - Perú . 2016;1-16. Available from: http://bvs.minsa.gob.pe/local/MINSA/3971.pdf [ Links ]

2. Domek N, Dux K, Pinzur M, Weaver F, Rogers T. Association Between Hemoglobin A1c and Surgical Morbidity in Elective Foot and Ankle Surgery. J Foot Ankle Surg . 2016;55(5):939-43. Available from:http://dx.doi.org/10.1053/j.jfas.2016.04.009 [ Links ]

3. Cancienne JM, Werner BC, Browne JA. Is There a Threshold Value of Hemoglobin A1c That Predicts Risk of Infection Following Primary Total Hip Arthroplasty? J Arthroplasty . 2017;32(9):S236-40. Available from:http://dx.doi.org/10.1016/j.arth.2017.01.022 [ Links ]

4. M. C. Martín Muñoz, A. Gómez de la Cámara, a. Román Martínez, p. Ferrando Vivas, M. E. Albarrán Juan Fh. Riesgo de infecciones y control metabólico en pacientes con diabetes mellitus tipo 2. An Med Interna . 2004;21(3):28043. Available from:http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0212-71992004000300004 [ Links ]

5. Jupiter DC, Humphers JM, Shibuya N. Trends in postoperative infection rates and their relationship to glycosylated hemoglobin levels in diabetic patients undergoing foot and ankle surgery. J Foot Ankle Surg . 2014;53(3):307-11. Available from: http://dx.doi.org/10.1053/j.jfas.2013.10.003 [ Links ]

6. Humphers JM, Shibuya N, Fluhman BL, Jupiter D. The impact of glycosylated hemoglobin and diabetes mellitus on wound-healing complications and infection after foot and ankle surgery. J Am Podiatr Med Assoc . 2014;104(4):320-9. Available from: shttp://www.ncbi.nlm.nih.gov/pubmed/25076074 [ Links ]

Financing: Self-financed

Received: November 15, 2019; Accepted: December 26, 2019

Correspondence: Angela Marcela Villanueva Del Busto Address: Jr. Vulcano Mz. D Lot 1. Urb. Santa Modesta, Santiago de Surco. Telephone: 987758961 E-mail:marcelavillanuevadelbusto@gmail.com

Authorship Contributions: The authors participated in the conception, collection of information, writing and approval of the final version of the article

Interest conflict: The authors declare no conflicts of interest in the publication of this article

Creative Commons License Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons

 
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