{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:07:52Z","timestamp":1792620472438,"version":"4.5.0"},"reference-count":40,"publisher":"American Diabetes Association","issue":"6","license":[{"start":{"date-parts":[[2018,5,21]],"date-time":"2018-05-21T00:00:00Z","timestamp":1526860800000},"content-version":"vor","delay-in-days":56,"URL":"http:\/\/www.diabetesjournals.org\/content\/license"}],"funder":[{"DOI":"10.13039\/501100000930","name":"National Stroke Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000930","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008717","name":"Sylvia and Charles Viertel Charitable Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008717","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008639","name":"Sir Edward Weary Dunlop Medical Research Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008639","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001232","name":"Royal Australasian College of Physicians","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001232","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000971","name":"Diabetes Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000971","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,6,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>Limited studies have examined the association between diabetes and HbA1c with postoperative outcomes. We investigated the association of diabetes, defined categorically, and the association of HbA1c as a continuous measure, with postoperative outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>In this prospective, observational study, we measured the HbA1c of surgical inpatients age \u226554 years at a tertiary hospital between May 2013 and January 2016. Patients were diagnosed with diabetes if they had preexisting diabetes or an HbA1c \u22656.5% (48 mmol\/mol) or with prediabetes if they had an HbA1c between 5.7 and 6.4% (39 and 48 mmol\/mol). Patients with an HbA1c &amp;lt;5.7% (39 mmol\/mol) were categorized as having normoglycemia. Baseline demographic and clinical data were obtained from hospital records, and patients were followed for 6 months. Random-effects logistic and negative binomial regression models were used for analysis, treating surgical units as random effects. We undertook classification and regression tree (CART) analysis to design a 6-month mortality risk model.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Of 7,565 inpatients, 30% had diabetes, and 37% had prediabetes. After adjusting for age, Charlson comorbidity index (excluding diabetes and age), estimated glomerular filtration rate, and length of surgery, diabetes was associated with increased 6-month mortality (adjusted odds ratio [aOR] 1.29 [95% CI 1.05\u20131.58]; P = 0.014), major complications (1.32 [1.14\u20131.52]; P &amp;lt; 0.001), intensive care unit (ICU) admission (1.50 [1.28\u20131.75]; P &amp;lt; 0.001), mechanical ventilation (1.67 [1.32\u20132.10]; P &amp;lt; 0.001), and hospital length of stay (LOS) (adjusted incidence rate ratio [aIRR] 1.08 [95% CI 1.04\u20131.12]; P &amp;lt; 0.001). Each percentage increase in HbA1c was associated with increased major complications (aOR 1.07 [1.01\u20131.14]; P = 0.030), ICU admission (aOR 1.14 [1.07\u20131.21]; P &amp;lt; 0.001), and hospital LOS (aIRR 1.05 [1.03\u20131.06]; P &amp;lt; 0.001). CART analysis confirmed a higher risk of 6-month mortality with diabetes in conjunction with other risk factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Almost one-third of surgical inpatients age \u226554 years had diabetes. Diabetes and higher HbA1c were independently associated with a higher risk of adverse outcomes after surgery.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc17-2304","type":"journal-article","created":{"date-parts":[[2018,3,26]],"date-time":"2018-03-26T19:15:12Z","timestamp":1522091712000},"page":"1172-1179","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":90,"title":["The Presence of Diabetes and Higher HbA1c Are Independently Associated With Adverse Outcomes After Surgery"],"prefix":"10.2337","volume":"41","author":[{"given":"Priscilla H.","family":"Yong","sequence":"first","affiliation":[{"name":"Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Weinberg","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niloufar","family":"Torkamani","sequence":"additional","affiliation":[{"name":"Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia"},{"name":"Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonid","family":"Churilov","sequence":"additional","affiliation":[{"name":"The Florey Institute of Neuroscience & Mental Health, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond J.","family":"Robbins","sequence":"additional","affiliation":[{"name":"Department of Administrative Informatics, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Ma","sequence":"additional","affiliation":[{"name":"Clinical Costing Finance, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rinaldo","family":"Bellomo","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia"},{"name":"Centre for Integrated Critical Care, The University of Melbourne, Parkville, Victoria, Australia"},{"name":"Australian and New Zealand Intensive Care Society Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Que T.","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Pathology, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D.","family":"Burns","sequence":"additional","affiliation":[{"name":"Clinical Informatics Unit, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graeme K.","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy F.","family":"Lew","sequence":"additional","affiliation":[{"name":"Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8739-7896","authenticated-orcid":false,"given":"Johan","family":"M\u00e5rtensson","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia"},{"name":"Section of Anesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Story","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia"},{"name":"Centre for Integrated Critical Care, The University of Melbourne, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew N.","family":"Motley","sequence":"additional","affiliation":[{"name":"Quality and Patient Safety Unit, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia"},{"name":"Department of General Medicine, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey 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