Is There a Role for Diabetes Stewardship in Orthopaedics? Observations From a Hand and Upper Extremity Surgery Clinic.

Abstract

Although generally safe, corticosteroid injections (CSI) have notable adverse effects including hyperglycemia. Despite this, point-of-care blood glucose (POC BG) testing before administration has not been described. Over the past 4 years, our hand and upper extremity surgery clinic has begun screening diabetic patients with a POC BG test before CSI. Patients with a POC BG greater than 150 mg/dL were refused a CSI and referred to their medical provider for glucose management. We sought to understand the incidence of patients who presented with uncontrolled diabetes and rates of follow-up and medication adjustment with their medical provider. Two hundred seven patients received POC BG testing in our tertiary referral hand and upper extremity surgery clinic between 2018 and 2022. Patient demographics, POC BG, hemoglobin A1C pre and post visit, medication regimen, and the timing and intervention by their medical provider were recorded. Eighty-one patients (39.1%) had a POC BG greater than 150 mg/dL (mean 236.4 ± 76.7 mg/dL). Fifty-nine (72.8%) successfully followed up with their medical provider within 33.2 ± 38.0 days, and 24 (40.7%) required a diabetes medication adjustment or addition. Two were referred to the emergency department for POC BG of 578 and 401 mg/dL. One required a course of insulin, potassium, and intravenous fluids. Patients who successfully followed up for glucose management saw a decrease in hemoglobin A1C of 0.40% ± 1.37%, whereas those who did not follow-up saw an increase of 0.35% ± 1.35% (P = 0.037) over 18 months following their preappointment value. The incidence of poorly controlled blood glucose in our community was high. However, the rate of diabetes follow-up was also surprisingly high and timely. This illustrates potential short- and long-term benefits of diabetic screening before CSI. These observations suggest that a short delay in patient satisfaction may result in more lasting changes in a patient's overall health. Level IV-Retrospective review of medical records.