Is There a Role for Diabetes Stewardship in Orthopaedics? Observations From a Hand and Upper Extremity Surgery Clinic
Bibliographic record
Abstract
INTRODUCTION: Although generally safe, corticosteroid injections (CSI) have notable adverse effects including hyperglycemia. Despite this, point-of-care blood glucose (POC BG) testing before administration has not been described. Over the past 4 years, our hand and upper extremity surgery clinic has begun screening diabetic patients with a POC BG test before CSI. Patients with a POC BG greater than 150 mg/dL were refused a CSI and referred to their medical provider for glucose management. We sought to understand the incidence of patients who presented with uncontrolled diabetes and rates of follow-up and medication adjustment with their medical provider. METHODS: Two hundred seven patients received POC BG testing in our tertiary referral hand and upper extremity surgery clinic between 2018 and 2022. Patient demographics, POC BG, hemoglobin A1C pre and post visit, medication regimen, and the timing and intervention by their medical provider were recorded. RESULTS: Eighty-one patients (39.1%) had a POC BG greater than 150 mg/dL (mean 236.4 ± 76.7 mg/dL). Fifty-nine (72.8%) successfully followed up with their medical provider within 33.2 ± 38.0 days, and 24 (40.7%) required a diabetes medication adjustment or addition. Two were referred to the emergency department for POC BG of 578 and 401 mg/dL. One required a course of insulin, potassium, and intravenous fluids. Patients who successfully followed up for glucose management saw a decrease in hemoglobin A1C of 0.40% ± 1.37%, whereas those who did not follow-up saw an increase of 0.35% ± 1.35% ( P = 0.037) over 18 months following their preappointment value. DISCUSSION: The incidence of poorly controlled blood glucose in our community was high. However, the rate of diabetes follow-up was also surprisingly high and timely. This illustrates potential short- and long-term benefits of diabetic screening before CSI. These observations suggest that a short delay in patient satisfaction may result in more lasting changes in a patient's overall health. LEVEL OF EVIDENCE: Level IV-Retrospective review of medical records.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".