By Jesse Shen, MD, Virginia Mason Medical Center and
Rajiv Sethi, MD, Virginia Mason Medical Center
The Bad News
Type 2 diabetes (diabetes mellitus) is a chronic disease that tremendously impacts patients and society. The Center for Disease Control (CDC) estimates that 11.3% of the American population has diabetes and that almost 40% of the adult population in America has pre-diabetes1. This number is staggering and shows how common this disease is.
Not only is it common, but diabetes has severe effects on a person’s health and well-being. The impact of diabetes is due to its complications if left untreated. Complications such as heart attacks and strokes can increase patients’ mortality risk. However, when diabetes is well-controlled, some of these negative effects can be reversed in this patient population2.
The impact of diabetes is also expressed in spine diseases and spine surgery. Patients who have uncontrolled diabetes are at higher risk of surgical complications. These are serious considerations as it increases the risk of infection, heart attacks, and blood clots which puts patients at higher risk of mortality after surgery4. Moreover, the average hospital stay for patients with uncontrolled diabetes is longer. It is clear that diabetes can seriously impact spine patients.
Not only does uncontrolled diabetes affect complications after surgery, but it could also impact the quality of life and outcomes following surgery. Recent articles have shown that patients with diabetes have worse clinical outcomes compared to those who do not have diabetes. These effects were felt two years after surgery5. Diabetes impacts all facets of a patient’s postoperative well-being, from complications to outcomes.
The Good News: Controlling Your Diabetes Can Have Great Benefits for Your Spine Health
Fortunately, care teams can mitigate these adverse effects by helping patients adequately control diabetes before spine surgery. A recent publication showed that controlling diabetes to specific targets can improve outcomes and reduce complications following spine surgery6. Also, it has long been known that when diabetes is controlled, it can decrease the complications related to this disease7. Furthermore, well-controlled diabetes can improve quality of life, short-term symptoms, and even economic considerations such as less absenteeism for workers3. The benefits of diabetes control are enormous for patients. Therefore, managing diabetes is critical for a patient’s well-being, not only for spine surgery.
The evidence is compelling for patients to control type 2 diabetes adequately. Improving a patient’s health by managing diabetes goes well beyond the impacts of spine surgery. Each patient needs to have their diabetes well-controlled to have the best surgical outcome and overall well-being. We recommend that patients consider and follow recommendations for proper blood sugar control for diabetes. The evidence suggests that controlling your diabetes can have great benefits for your spine health.
- Centers for Disease Control. National Diabetes Statistics Report. 2022 [cited 2022 August 9th 2022]; Available from: https://www.cdc.gov/diabetes/data/statistics-report/index.html.
- Kianmehr, H., et al., Potential Gains in Life Expectancy Associated With Achieving Treatment Goals in US Adults With Type 2 Diabetes. JAMA Network Open, 2022. 5(4): p. e227705-e227705.
- Testa, M.A. and D.C. Simonson, Health Economic Benefits and Quality of Life During Improved Glycemic Control in Patients With Type 2 Diabetes MellitusA Randomized, Controlled, Double-Blind Trial. JAMA, 1998. 280(17): p. 1490-1496.
- Guzman, J.Z., et al., Outcomes and complications of diabetes mellitus on patients undergoing degenerative lumbar spine surgery. Spine (Phila Pa 1976), 2014. 39(19): p. 1596-604.
- Armaghani, S.J., et al., Diabetes Is Related to Worse Patient-Reported Outcomes at Two Years Following Spine Surgery. J Bone Joint Surg Am, 2016. 98(1): p. 15-22.
- Roth, S.G., et al., Optimal hemoglobin A1C target in diabetics undergoing elective cervical spine surgery. Spine J, 2022. 22(7): p. 1149-1159.
- Gaster, B. and I.B. Hirsch, The Effects of Improved Glycemic Control on Complications in Type 2 Diabetes. Archives of Internal Medicine, 1998. 158(2): p. 134-140.