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Diabetes Type Affects Joint Replacement Outcomes

People with type 1 diabetes who undergo total hip or knee replacement generally fare worse than people with type 2 diabetes, who in turn do worse than non-diabetic patients, according to study findings.

Researcher Dr. Michael P. Bolognesi, from Duke University Medical Center in Durham, North Carolina, stated that, "The biggest finding was that diabetes predicted higher complication rates, and this is obviously not a huge surprise."

While type 1 diabetic patients overall did worse than type 2 diabetics, he added, the very worst outcomes were actually seen in a subgroup of type 2 diabetics with uncontrolled disease.

The findings are based on an analysis of data for 65,769 diabetic patients who underwent joint replacement surgery and were entered in a database from 1988 to 2003.

Compared with patients with type 2 diabetes, those with type 1 diabetes had significantly longer hospital stays and higher costs following surgery after adjusting for inflation.

Type 1 diabetics were also at increased risk for a heart attack, pneumonia, urinary tract infection, post-operative bleeding, wound infection, and death.

The team’s analysis suggests that these patients can be helped by making sure their blood glucose levels are under control before the operation and during the recovery period, Bolognesi pointed out.

Furthermore, he emphasized, "Physicians need to be aware of the fact that these patients do worse across the board, and do everything they can to minimize complications — and be ready to address them, as they will likely occur."

Presented last week at the meeting of the American Academy of Orthopaedic Surgeons in San Francisco. March 6th, 2008
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DID YOU KNOW:
Celiac Disease And Diabetes Have Genetic Link: London researchers suggest celiac disease and diabetes may have common genetic origins. David van Heel of Barts and The London School of Medicine and Dentistry demonstrated that of the nine celiac gene regions now known, four are also predisposing factors for type 1 diabetes. Researchers, performed a genome-wide association study in celiac disease. Genetic markers across the genome were compared in celiac disease subjects versus healthy controls. The researchers identified seven new risk regions, six of which harbor important genes critical in the control of immune responses, highlighting their significance in the development of the disease. Celiac disease, triggered by an intolerance to gluten — a protein found in wheat, barley and rye can lead to anemia, poor bone health, fatigue and weight loss. the journal Nature Genetics March 2008

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