Perspectives on Glycemic Control for Diabetic Foot Surgery

So my name is Brian Schmidt. I'm a clinical associate professor at the University of Michigan Medical School in Ann Arbor, Michigan, and I'm a podiatrist by training.
 
What are the current guidelines or recommendations on glycemic control as it related to diabetic foot surgery?
 
So with respect to diabetic foot surgery and glycemic control, there isn't any nationalized or standardized guidelines. The thought is if you're doing surgery on somebody who is Hospitalized, it is better to per se keep them sweet so that they don't have complications of hypoglycemia. However, We know from longitudinal studies of the past decades that, hyperglycemia, especially a1c over 88%, are associated with complications not just in foot surgery, but complications in cardiovascular health, longevity, and any type of surgery.
 
So that is true, and other surgeries can be applied to diabetic foot, and we should still follow those standards that, in general, people who have better controlled, hemoglobin a1c and blood sugars before surgery are much less likely to have an adverse event following a surgery.
 
What are the debates surrounding how this metric affects outcomes?
 
Yeah. So the novel or the most difficult thing to entertain now is kind of the emergence of continuous glucose monitors. These devices that tell a person If they're in range and what percentage they're in range, and there's some novel data that really tells us that, yes, tighter control is better, but there is not published guidelines in foot and ankle medicine or foot and ankle surgery, which tells us that this is the absolute threshold where you need to be. So I would say pay attention to that data because a1c, remember, is a marker of blood sugar control over a period of 3 months, usually the immediate preceding 3 months.
 
So it's not really useful for day of surgery and the time thereafter. However, these time and range monitors, you can measure that weekly and see how does that impact wound healing and, surgical site infection rates, and I think that's emerging, so I would pay attention to that literature.