{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T09:52:11Z","timestamp":1790157131693,"version":"4.0.1"},"reference-count":36,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Medical Research Council Population Health and Health Services Research Clinician Scientist Award \u2013 Investigator, Ministry of Health, Singapore","award":["HCSAINV22jul-0002"],"award-info":[{"award-number":["HCSAINV22jul-0002"]}]},{"name":"SingHealth-Duke NUS Anaesthesiology Academic Clinical Program Pilot Research Grant 2019","award":["ANAESPRG19\/04"],"award-info":[{"award-number":["ANAESPRG19\/04"]}]},{"name":"National Medical Research Council Research Training Fellowship, Ministry of Health, Singapore","award":["MOH-RTF21nov-0003"],"award-info":[{"award-number":["MOH-RTF21nov-0003"]}]},{"name":"National Medical Research Council Research Training Fellowship, Ministry of Health, Singapore","award":["MOH-RTF24jan-0022"],"award-info":[{"award-number":["MOH-RTF24jan-0022"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Med Insights Endocrinol Diabetes"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Diabetes mellitus (DM) is a critical risk factor associated with postoperative complications. Preoperative glycemic control, commonly assessed by glycated hemoglobin (HbA1c), may help stratify patients with DM. However, association between DM, HbA1c levels and perioperative outcomes in multi-ethnic Asian populations with distinct cardiometabolic profiles remains underexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>This study aimed to study the association between pre-existing DM, suboptimal glycemic control (HbA1c \u2265 7%), and postoperative complications in elective non-cardiac surgical patients, focusing on the role of HbA1c as a risk stratification tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This secondary analysis included 688 patients from a prospective cohort at Singapore\u2019s largest tertiary hospital. Postoperative complication(s) were assessed using the Comprehensive Complication Index. Patients were categorized into 2 groups\u2014DM (regardless of HbA1c) and no DM (HbA1c \u2264 6%). We used multivariable logistic regression to explore associations within the entire cohort and DM subgroup. The relationship between preoperative HbA1c levels and postoperative complication(s) was also explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The overall incidence of postoperative complication(s) was 20.78%. DM was independently associated with increased postoperative complication(s) (adjusted OR 2.57, 95% CI 1.20-5.50,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .015). A trend toward a higher likelihood of postoperative complication(s) was observed in patients with DM and suboptimal glycemic control (adjusted OR 1.39, 95% CI 0.56-3.45,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .482) though this did not reach statistical significance. A noteworthy U-shaped relationship was identified between preoperative HbA1c levels and postoperative complication(s), with increased complications at both low and high HbA1c levels.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This study highlights a significant association between DM and increased postoperative complications. The observed U-shaped relationship between HbA1c levels and complications underscores the need for comprehensive risk assessment across the full glycemic spectrum. Routine HbA1c screening and tailored perioperative strategies in multi-ethnic Asian populations could enhance surgical outcomes, reduce healthcare costs, and support broader public health goals in DM management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11795514251356572","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T08:17:13Z","timestamp":1753258633000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Diabetes Mellitus, Preoperative Glycemic Control and Postoperative Outcomes: A Multi-Ethnic Asian Perspective"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6515-2756","authenticated-orcid":false,"given":"Roderica Rui Ge","family":"Ng","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology &amp; Perioperative Medicine, Singapore General Hospital, Singapore, Singapore"},{"name":"Duke-NUS Medical School, Singapore, Singapore"},{"name":"Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9392-2914","authenticated-orcid":false,"given":"Charlene Xian Wen","family":"Kwa","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology &amp; Perioperative Medicine, Singapore General Hospital, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7193-4749","authenticated-orcid":false,"given":"Yuhe","family":"Ke","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology &amp; Perioperative Medicine, Singapore General Hospital, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2504-3341","authenticated-orcid":false,"given":"Brenda Pei Yi","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology &amp; Perioperative Medicine, Singapore General Hospital, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5338-6248","authenticated-orcid":false,"given":"Mengling","family":"Feng","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore"},{"name":"Institute of Data Science, National University of Singapore, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1916-0832","authenticated-orcid":false,"given":"Hairil Rizal","family":"Abdullah","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology &amp; Perioperative Medicine, Singapore General Hospital, Singapore, Singapore"},{"name":"Duke-NUS Medical School, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X221114900"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/ans.17674"},{"key":"#cr-split#-e_1_3_2_4_2.1","unstructured":"Talking Point 2023\/2024 - Diabetes [Internet]. ChannelsNewAsia"},{"key":"#cr-split#-e_1_3_2_4_2.2","unstructured":"October 23 2023. Accessed June 14 2024. https:\/\/sph.nus.edu.sg\/2023\/10\/talking-point-2023-2024-diabetes\/#:~:text=The%20escalating%20prevalence%20of%20diabetes it%20under%20control%20is%20essential"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.841256"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc17-2304"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2022.106789"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-020-02373-9"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23624"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)15268-3"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/dme.15380"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-76105-2"},{"key":"e_1_3_2_13_2","unstructured":"Ministry of Health and Health Promotion Board Singapore. National Population Health Survey 2022 (Household Interview and Health Examination) [Internet]. Ministry of Health and Health Promotion Board Singapore; September 2023. Accessed May 18 2025. https:\/\/isomer-user-content.by.gov.sg\/3\/28c3b8f9-9216-46be-8fc9-b614098666a9\/nphs-2022-survey-report_final.pdf"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(22)00133-4"},{"key":"e_1_3_2_15_2","unstructured":"Ministry of Health Singapore. White Paper on Healthier SG [Internet]. Ministry of Health Singapore; September 2022. Accessed June 14 2024. https:\/\/file.go.gov.sg\/healthiersg-whitepaper-pdf.pdf"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318296c732"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000948"},{"key":"e_1_3_2_19_2","unstructured":"Ministry of Health Singapore. Chronic Disease Management Programme: Handbook for Healthcare Professionals 2024 [Internet]. Ministry of Health Singapore; November 2024. Accessed April 26 2025. https:\/\/www.primarycarepages.sg\/schemes-and-programmes\/Documents\/Chronic%20Disease%20Management%20Programme%20%28CDMP%29%20Handbook%20for%20Healthcare%20Professionals%202024.pdf"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-29998-z"},{"key":"e_1_3_2_21_2","unstructured":"American Diabetes Association. What is the A1C Test? [Internet]. American Diabetes Association; 2024. 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