The correlation of HbA1c levels on the healing process of postoperative fractures in diabetes mellitus patients

https://doi.org/10.19106/JMedSci005204202008

Elanda Putri Madyaningtias(1*), Arman Bausat(2), Jufri Latief(3), Nasser Mustari(4), Joko Hendarto(5), Prihantono Prihantono(6)

(1) Department of Surgery, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia
(2) Division of Orthopedic Surgery, Department of Surgery, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia
(3) Division of Orthopedic Surgery, Department of Surgery, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia
(4) Division of Orthopedic Surgery, Department of Surgery, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia
(5) Department of Public Health, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia
(6) Department of Surgery, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia
(*) Corresponding Author

Abstract


Fracture is defined by the loss of bone or cartilage continuity, either total or partial. Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both. HbA1c could be used as a diagnostic tool and determines the glycaemic control of DM patients. This study aimed to investigate the correlation between serum HbA1c levels and the healing process of postoperative fractures in DM patients. This was an observational study with a retrospective cohort design. The study population was DM patients who were admitted to the Department of Emergency, Dr. Wahidin Sudirohusodo General Hospital, Makassar due to long bone fracture within the period of September 2019-February 2020. The bone fractures healing was evaluated based on the radiographic union scale in tibial fractures (RUST) scores. The results are analysed using the Chi-square test. A total of 70DM patients who underwent fracture reduction surgery were involved in this study. Out of 35 patients with controlled DM (HbA1c <7%), we obtained 24 (68.6%) patients and 11 (31.4%) patients with good and delayed union, respectively. The other 35 patients had uncontrolled DM (HbA1c >7%), and there were 13 (37.1%) patients and 22 (62.9%) patients with good and delayed union, respectively. The Chi-square test showed a significant relationship (p= 0.008). It can be concluded that the increase in HbA1c levels was related to the obstacles in bone fractures healing. Moreover, an infection contributes to the healing status of bone fractures.


Keywords


diabetes mellitus; HbA1c; fracture; long bones; RUST score;

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References

  1. Romeo NM. Femur injuries and fractures. MedScape [serial online], 2018. Available from: http://www.emedicine.medscape.com/article/90779-overvie
  2. Conway BN, Long DM, Figaro MK, May ME. Glycemic control and fracture risk in elderly patients with diabetes. Diabetes Res Clin Pract 2016; 115:47-53. https://doi.org/10.1016/j.diabres.2016.03.009
  3. Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomarker Insights 2016; 11:95-104. https://doi.org/10.4137/BMI.S38440
  4. Gulcelik NE, Bayrakter M, Caglar O, Alpalsan M, Karakaya J. Mortality after hip fracture in diabetic patients. Exp Clin Endocrinol Diabetes 2011; 119(7):414-8. https://doi.org/10.1055/s-0030-1270466
  5. Whelan DB, Bhandari M, Stephen D, Kreder H, McKee MD, Zdero R, et al. Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Trauma 2010; 68:629-32.
  6. Liqing Y, Yuefeng S, Jiulong L. Is hemoglobin A1c and perioperative hyperglycemia predictive of periprosthetic joint infection following total joint arthroplasty?. Medicine 2017; 96:51(e8805). https://doi.org/10.1097/MD.0000000000008805
  7. Zura R, Forbes MJ, Jeray K, Mehta S, Einhorn TA, Watson JT, et al. Bone fracture non-union rate decreases with increasing age: A prospective inception cohort study. Bone 2017; 95:26-32. https://doi.org/10.1016/j.bone.2016.11.006
  8. Al-Hakeim HK, Abdulzahra MS. Correlation between glycated haemoglobin and homa indices in type 2 diabetes mellitus: prediction of beta-cell function from glycated hemoglobin. J Biochem Med 2015; 34(2):191. https://doi.org/10.2478/jomb-2014-0033
  9. Wang L, Li T, Liu J, Wu X, Wang H, Li X, et al. Association between glycosylated hemoglobin A1c and bone biochemical markers in type 2 diabetic postmenopausal women: a corss- sectional study. BMC Endocr Disord 2019; 19(31):3. http://doi.org/10.1186/s12902-019-0357-4
  10. Thraikill KM, Lumpkin CK, Bunn RC, Kemp SF, Fowlkes JL. Is insulin an anabolic agent in bone? Dissecting the diabetic bone for clues. Am J Physiol Endocrinol Metab 2005; 289(5):2. https://doi.org/10.1152/ajpendo.00159.2005
  11. Clark D, Nakamura M, Miclau T, Marcucio R. Effects of aging on fracture healing. Curr Osteoporos Rep 2017; 15(6):60. https://doi.org/10.1007/s11914-017-0413-9
  12. Gandhi A, Beam HA, O’Connor JP, Parsons JR, Lin SS. The effects of local insulin delivery on diabetic fracture healing. Bone 2005; 37(4):482-90. https://doi.org/10.1016/j.bone.2005.04.039
  13. Hygum K, Linde JS, Langdahl BL. Diabetes and bone. Osteoporosis Sarcopenia 2019; 5(2):29-37. https://doi.org/10.1016/j.afos.2019.05.001
  14. Sadighi A, Bazavar M, Niafar M, Tabrizi A, Doorandish N. Effects of diabetes mellitus type II on long bones fractures healing. ABC Med 2015; 3(3):14-5. https://doi.org/10.7575/aiac.abcmed.15.03.03.03
  15. Jiao H, Xiao E, Graves DT. Diabetes and its effect on bone fracture healing. Curr Osteoporos Rep 2015; 13(5):327-35. https://doi.org/10.1007/s11914-015-0286-8
  16. Henderson S, Ibe I, Cahill S, Chung YO, Lee FY. Bone quality and fracture-healing in type-1 and type-2 diabetes mellitus. J Bone Joint Surg Am 2019; 101(15):1399-410. https://doi.org/10.2016/JBJS.18.01297



DOI: https://doi.org/10.19106/JMedSci005204202008

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