PIG Meeting: 11th February 2021

Follow on from recent PIG patient, booked for TKR, with poorly controlled diabetes among her many comorbidities. Qualification sought from surgeons about their accepted preop HbA1c. Surgical team advised that max 7.5% accepted but that fructosamine level may be used if patient is borderline, as a means to either justify or refuse surgery.

Discussion

• What is fructosamine?
  • Refers to glycosylation of plasma proteins, predominantly albumin.
  • Higher plasma glucose levels lead to increased glycosylation (similar to glycosylation of Hb)

• What is its significance?
  • Plasma proteins have shorter t1/2 than Hb, so it fructosamine level reflects glucose control over the previous 2-3wks.

• What does it mean in context of surgery?
  • Limited evidence for HbA1c correlating with postoperative outcomes (and no evidence for 7.5% v. 8.5% cutoff)
  • Evidence exists for improved outcomes with better glucose control in the more immediate perioperative period.
  • 2019 paper showing correlation between higher preop fructosamine levels and higher rates of periprosthetic joint infection, reoperation and readmission. Although significant potential issues about the validity of this trial

• Should we be targeting fructosamine instead of HbA1c?
  • May be a target in the future but this would require a review of evidence and agreement between the orthopaedic surgeons, periop service and endocrinology service.

• What are the details of the test itself?
  • At JHH 10-30 of these processed daily
  • Run 24h a day, with a turnaround time similar to a UEC.
  • Cost – Awaiting advice from pathology revenue department.