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A1c Not Linked to Postop Complications in Kids With Diabetes

Miriam E. Tucker



  • No associations were found between preoperative A1c levels and postoperative infection, wound, or ketosis complications in children with type 1 or type 2 diabetes undergoing elective noncardiac surgery or diagnostic procedures.
  • Delaying elective surgeries until A1c is consistently normalized may not be warranted, particularly because this is challenging to accomplish rapidly.


  • A retrospective analysis was done of data from surgery and endocrinology medical records of 438 children aged 1-18 years with type 1 (72%) or type 2 diabetes (28%) undergoing elective noncardiac surgery at Texas Children's Hospital, January 2011 to June 2021.
  • Overall, 28% had an A1c < 7.0%, 42% had A1c ≥ 7% to < 9%, and 30% had A1c > 9%.
  • The primary outcome was defined as a new-onset postoperative systemic infection, wound complication, or ketosis.


  • The incidence of any postoperative systemic infections was 0.91% (n = 4); postoperative wound disruption, 3.33% (n = 19); and postoperative ketosis, 3.89% (n = 17).
  • A1c levels were not associated with any postoperative systemic infections, wound complications, or ketosis.
  • No other preoperative factors, including diabetes type, body mass index, or procedure type, were association with these complications.


"Current recommendations suggest consulting with the diabetes team before surgery and if glycemic status is suboptimal to consider delaying surgery and, if surgery cannot be delayed, considering admission to the hospital before surgery for acute optimization of glycemia, However, there is no guidance on the level of elevated A1c that should prompt consideration of delaying surgery. This issue is of crucial importance because necessary elective surgery or diagnostic procedures may be delayed unnecessarily or for longer than needed in children with elevated A1c because of the difficulty of improving A1c levels rapidly."


The study was led by Grace Kim, MD, of the Division of Diabetes and Endocrinology, Texas Children's Hospital, Houston, Texas. It was published online August 1, 2023, in Diabetes Care.


  • The postoperative complication rate was low.
  • Only elective procedures were included.


The authors have no disclosures.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. She is on Twitter @MiriamETucker.

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