Implementation of a Diabetes Risk Screening Instrument in the Preoperative Setting for Total Joint Orthopedic Patients

The national CDC (2017) statistics revealed 23 million cases of diabetes and 84.1 million cases of prediabetes, which is nearly 4x more prevalent than diabetes. Among United States (US) adults aged 18 years or older in 2015, 33% were diagnosed with prediabetes and only 10.6% reported awareness. Within the surgical realm of healthcare, an estimated 25% of patients with diabetes will require surgery at some point and 5 to 10% of patients who present for surgery are found to have previously undiagnosed diabetes (Setji et al., 2017). Identifying diabetic and prediabetic patients preoperatively supports targeted interventions to reduce the risks of complications. Yet, preoperative diabetic screening protocols are not consistently applied. The purpose of this paper is to present an evidence-based practice project examining the influence of implementing a preoperative diabetic screening process in an elective total joint orthopedic patient population. The American Diabetes Association (ADA) Diabetes Risk Screening Instrument was used to assess diabetes risk and guide further testing for adult patients undergoing elective total joint orthopedic surgeries. Throughout the 8-week screening period, a total of 121 total joint orthopedic patients were screened. Of the sample, 55 were undiagnosed and at-risk for diabetes according to the ADA screening instrument. Complete data were collected on this sample. Twelve (21.8%) patients who screened at-risk on the instrument also revealed elevated fasting blood glucose measurements. These patients were identified as potentially pre-diabetic. Eight of the 12 had no family history. Without preoperative screening, the diagnosis of prediabetes would have been missed. The findings of this project support adoption of the ADA screening instrument and further emphasize the feasibility of integration into the preoperative screening process, providing valuable information which contributes to comprehensive patient care.