Clinical trial NCT03306810: Recognition and Treatment of Dysglycemia. AGS - Acute Glucose Service
Official title: Recognition and Treatment of Dysglycemia in Elective Knee and Hip Arthroplasties. AGS - Acute Glucose Service
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Dysglycemia
Arthroplasty Complications
Keywords: Perioperative complications
Dysglycemia management team
Nurse Practitioner
Hospital
Lead sponsor: Joint Authority for Päijät-Häme Social and Health Care
Sponsor class: OTHER
First posted: 2017-10-11
Enrollment: 600
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: AGS (Acute Glucose Service ) is an inpatient glucose management service consisting of Nurse Practitioner and physician. Team manages not - consulted- based preoperative assessment, perioperative glucose control, patient education and supervision, but also transition of care postoperatively. The goal is to detect and treat dysglycemias , but also provide an active and constantly ongoing education to other hospital teams.

AGS improves better overall- survival of arthroplastic patients and is an effective way to recognize and treat dysglycemias and to organize constantly ongoing education.

Detailed description: 600 elective knee and hip arthroplastic patients are collected. 200 patients before AG- service will be compared to 400 patients after AGS. The latter group is divided to two 200 patients groups: 1) with AGS 2) with AGS extended to first control in 3 months (AG- nurse may be contacted by phone). Patients are followed up up to 5 years. Controls will be held after 3 months, 1 year and 5 years after operation including B-Hba1c, 15 D Quality of life assessment and patient interview.

There are several aims of the team and study: to detect, diagnose and optimize treatment (including medication) of diabetic/ dysglycemic patients from preoperative assessment 1 week before operation to postoperative care. With blood glucose target 42 - 86 mmol/mol results better overall survival, lesser complications (i.e. infections, cardiovascular or renal complications) and shorter length of hospital stay. Other aim is to find undiagnosed diabetics or those at risk of developing diabetes. One aim is to find risk factors, which lead to stress hyperglycemia during perioperative period or diabetes in 5 years.

Eligibility criteria: Inclusion Criteria:

* Patients aged \> 18 years
* Elective knee and hip arthroplasty patients

Exclusion Criteria:

* Patients who are incompetent to give informed consent
* Patients who are incompetent to assess their Quality-of-Life personally

Primary outcomes:
measure: Survival
timeFrame: 1-5 years
Secondary outcomes:
measure: Complications
timeFrame: 1-5 years
Other outcomes:
Locations:
city: Lahti
country: Finland
facility: Päijät-Häme Central Hospital
Study officials:
affiliation: Päijät Häme Central Hospital
name: Marianne Ylikoski, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Ylikoski M, Jokinen JJ, Lahtela J, Kauppi MJ, Huhtala H, Immonen H, Tiihonen R. Perioperative hyperglycaemia in elective arthroplasties. Should we do better? Acta Anaesthesiol Scand. 2020 Oct;64(9):1253-1261. doi: 10.1111/aas.13666. Epub 2020 Jul 30.