In patients before cardiac surgery, A1C criteria identified the largest number of patients with diabetes and prediabetes. For diagnosing prediabetes, A1C and FPG were discordant and characterized different groups of patients, therefore altering the distribution of diabetes risk. Simultaneous measurement of FGP and A1C may be a more sensitive and specific tool for identifying high-risk individuals with diabetes and prediabetes.

Background Deep sternal wound infections (DSWI) after cardiac surgery are a major cause of morbidity and mortality, especially in patients with diabetes mellitus (DM). Although data of postoperative blood glucose (BG) control on surgical outcomes is well established, the impact of a high A1C on morbidity and mortality is still unclear.Objective The purpose of this study was to evaluate the association between preoperative glucose control, as measured by A1C with postoperative outcomes especially DSWI, in cardiac surgery patients with known DM whose postoperative BG was controlled to a goal of 100-140 mg/dl.Methods This is a single-center, retrospective observational study of DM patients who were stratified according to their preoperative A1C: good glycemic control (A1C < 7.0%), moderate glycemic control (A1C 7.0-8.5%), and poor glycemic control (A1C > 8.5%). Postoperative glycemic management was standardized. Cox regression model was used to determine whether A1C was an independent risk factor of DSWI. ResultsIn 861 diabetes patients with similar postoperative BG control after cardiac surgery, the total incidence of DSWI was 2.8%. Six hundred and sixteen qualified and were stratified by A1C. DSWI rates were 2.3% in good glycemic control, 4.3% in moderate glycemic control, and 8.1% in poor glycemic control groups. After multivariate adjustment, a higher A1C was associated with an increased incidence of DSWI (hazard ratio = 1.38, P = 0.009).Conclusion In cardiac surgery patients with DM, despite standardized control of immediate postoperative hyperglycemia, a high preoperative A1C was associated with an increased incidence of DSWI. Cardiovasc Endocrinol 2:15-22 c 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Cardiovascular Endocrinology 2013, 2:15-22