gms | German Medical Science

Objectives: Treatment costs for diabetics lately exceeded 10 billion Euros per year in Germany. The second largest part of these costs is caused by the treatment of complications of the musculoskeletal system. It is assumed that pathological changes of bones already manifest during pre-diabetic states. Thus, this study aimed at determining the rate of pre-/diabetics in our level 1 trauma center and their risk for developing complications, furthermore, identifying a suitable screening method for the identified risk patients.

Methods: Over the course of 2 months, HbA1C was determined for all patients upon admission to a level 1 trauma center (Ethical vote: 454/2021BO2). The risk to develop diabetes was determined using the established questionnaires FINDRISK and GDRS. Patient-relevant data, e.g. department, length of hospital stay, and complications were extracted from the hospital information system 2 months after the last patient was recruited. Odds Ratios were determined by Chi-Square tests. Suitability of the Questionnaires was determined by ROC curves.

Results and conclusion: 1,036 Patients were included in the study. Of these 41% (N = 424) were identified as pre-diabetics and 15% (N=151) were identified as diabetics. About 1/4 of the diabetics have not been diagnosed up to this point. The rate of diabetics ranged from 11% (Arthroscopy) to 21% (Septic Surgery and Endoprothetics) and the rate of pre-diabetics ranged from 34% (Arthroscopy) to 51% (Endoprothetics). An elevated risk to develop pathological changes in bone (OD: 1.8 & 2.4), erysipelas/phlegmonas (OD: 1.7 & 2.3), infections (OD: 1.6 & 2.1), or sepsis (OD: 3.2 & 9.3) was already present in pre-diabetics and further increased when the disease manifests. Consequently, pre-diabetics stayed on average 1.5 days and diabetics 5.3 days longer in the hospital than controls. Both the FINDRISK and the GDRS questionnaire proved to be suitable to identify pre-diabetics with a ROCAUC of 0.71 and 0.74, respectively. Noteworthy, both questionnaires worked better for males (ROCAUC: 0.75 & 0.79) than for females (ROCAUC: 0.61 & 0.69).

We identified an unexpectedly high rate of pre-/diabetics. A risk to develop complications was already present in pre-diabetics, which further increased with the manifestation of the disease resulting in prolonged hospital stays. Studies suggest that close blood sugar control, also in non-diabetics, may prevent complications and mortality. Thus, routine screenings not only for diabetics but also for pre-diabetics in trauma centers are advised.