Continuation of Oral Anti-Diabetic Medications Was Associated With Better Early Post-Operative Blood Glucose Control Compared to Sliding Scale Insulin After Total Knee Arthroplasty.

BACKGROUND: This study evaluated blood glucose (BG), creatinine levels, metabolic issues, length of stay (LOS), and early post-operative complications in diabetic primary total knee arthroplasty (TKA) patients. It examined those who continued home oral anti-diabetic medications and those who switched to insulin post-operatively. The hypothesis was that continuing home medications would lead to lower BG levels without metabolic abnormalities.

METHODS: Patients diagnosed who had diabetes who underwent primary TKA from 2013 to 2022 were evaluated retrospectively. Diabetic patients who were not on home oral anti-diabetic medications or who were not managed inpatient post-operatively, were excluded. Patient demographics and laboratory tests collected pre- and post-operatively as well as 90-day emergency department (ED) visits and 90-day readmissions, were pulled from electronic records. Patients were grouped based on inpatient diabetes management: continuation of home medications versus new insulin coverage. Acute post-operative BG control, creatinine levels, metabolic abnormalities, LOS, and early post-operative complications were compared between groups. Multivariable regression analyses were performed to measure associations.

RESULTS: A total of 867 primary TKAs were assessed; 703 (81.1%) patients continued their home oral antidiabetic medications. Continuing home anti-diabetic medications demonstrated lower median maximum inpatient BG (180.0 mg/dL versus 250.0 mg/dL; P < 0.001) and median average inpatient BG (136.7 mg/dL versus 173.7 mg/dL; P < 0.001). Logistic regression analyses supported the presence of an association (OR [odds ratio] = 17.88 [8.66, 43.43]; P < 0.001). Proportions of acute kidney injury (AKI) (13.5 versus 26.7%; P < 0.001) were also lower. There was no difference in relative proportions of metabolic acidosis (4.4 versus 3.7%; P = 0.831), LOS (2.0 versus 2.0 days; P = 0.259), or early post-operative complications.

CONCLUSION: Continuing home oral anti-diabetic medications after primary TKA was associated with lower blood glucose levels without an associated worsening creatinine or increase in metabolic acidosis.