What is the clinical evidence from this study?

Study design: Case-Control. Population: Post-surgical Diabetic Ketoacidosis (DKA) (n=171). Intervention: Poor glycemic control (HbA1C ≥ 7%) vs. Good glycemic control (HbA1C < 7%). Primary outcome: Post-surgical DKA (OR 48.2, 95% CI 12.1-267.4, p=<0.001).

What question did this study set out to answer?

The research aims to explore the link between pre-surgical glycemic control and the occurrence of post-surgical diabetes ketoacidosis (DKA).

March 30, 2026Open Access

Post-surgical DKA stems from poor glycemic control prior to surgery and perioperative catecholamine usage: unmatched case–control study

Q: What are the key findings of this study?

Poor glycemic control prior to surgery (HbA1C ≥ 7%) significantly increased the odds of developing post-surgical diabetic ketoacidosis (OR 48.2).

Q: What question did this study set out to answer?

The research aims to explore the link between pre-surgical glycemic control and the occurrence of post-surgical diabetes ketoacidosis (DKA).

Key Result

Poor glycemic control prior to surgery (HbA1C ≥ 7%) significantly increased the odds of developing post-surgical diabetic ketoacidosis (OR 48.2).

Key Points

The research aims to explore the link between pre-surgical glycemic control and the occurrence of post-surgical diabetes ketoacidosis (DKA).
Conducted an unmatched case-control study sampling post-surgical DKA cases admitted to the ICU from 2019 to 2022.
Included a control group of adult post-surgical subjects without DKA during the same timeframe.
Evaluated glycemic control using glycosylated hemoglobin (HbA1C) levels and analyzed surgical details.
Identified 57 post-surgical DKA cases and 114 controls with a significant link to poor glycemic control (OR 48.2).
Sensitivity analysis showed a similar odds ratio for age and sex-matched cases and controls (OR 48.6).
Intraoperative use of catecholamines and insulin with prolonged surgery duration were significant predictors of post-surgical DKA (p<0.05).

Study Design

Type

Case-Control (n=171)

Multicenter

Structured PICO

Does poor pre-operative glycemic control increase the risk of post-surgical DKA in adult post-operative ICU patients?

Population

Adult (age ≥ 18) subjects admitted to the ICU post-operatively, including scheduled or emergency surgery

Intervention

Poor glycemic control (pre-operative HbA1C ≥ 7%)

Comparator

Good glycemic control (pre-operative HbA1C < 7%)

Outcome

Odds ratio of cases (post-surgical DKA) being exposed to the risk factor (HbA1C ≥ 7%) compared to controls

Poor pre-operative glycemic control (HbA1C ≥ 7%) and intraoperative catecholamine use are strongly associated with the development of post-surgical diabetic ketoacidosis.

Main Result

Effect estimate: OR 48.2 (95% CI 12.1-267.4)

Absolute Event Rate: 94.7% vs 27.2%

p-value: p=<0.001

Limitations

Many imbalanced variables were not matched in the primary analysis
Intraoperatively used insulin was more frequent among cases, contrary to its supposed protective effect
Catecholamines used as inotropes and prolonged duration of surgery were possible confounders

Abstract

Surgery is a well-known trigger of Diabetes Ketoacidosis, DKA. Post-surgical DKA is poorly studied in the current literature. This study investigated post-surgical DKA association with poor glycemic control before surgery. Unmatched case–control study sampling all post-surgical DKA cases admitted to ICU during the period from 1st of March 2019 to 1st of December 2022 in King Saud Medical City, Riyadh, Saudi Arabia. The control group comprises all other adult post-surgical subjects admitted to ICU without DKA during the same period. Poor glycemic control was considered when the glycosylated hemoglobin, HbA1C, was equal to or more than 7%. Details of surgery were collected from patients’ records. Fifty-seven post-surgical DKA cases were included and the control group consists of 114 subjects. Poor glycemic control was more frequent among postoperative DKA cases with a statistically significant difference (OR 48.2 95% CI: 12.1 – 267.4; p value < 0.001). Sensitivity analysis of fifty-four pairs of cases and controls matched for age and sex had odds ratio of 48.6 (95% CI: 12.1 – 267.4, p < 0.001). Multivariable logistic regression was done for independent predictor of postoperative DKA. Intraoperative catecholamine and insulin usage along with prolonged duration of surgery were statistically significant predictors (p values < 0.05). Post-surgical DKA was ascribed to poor glycemic control. The usage of catecholamine during surgery associated with postsurgical DKA and should be considered in future research.

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