CSP2023: 19 Are HbA1c & deprivation associated with mortality in type two diabetic hemiarthroplasty, hip fracture, patients. Single centre retrospective cohort study

Abstract

Purpose: The purpose of this study were to investigated if living in a more deprived area (measured by the index of multiple deprivation was associated with a higher mortality at 30 days and 1 year and if having a very low (<53mmol/mol) or high HbA1c(>64 mmol/mol) was associated with a higher mortality at 30 days and 1 year. The second aim was to explore if there was a connection between HbA1c and the index of multiple deprivation.

Methods: This was a single centre retrospective cohort study. 183 patients were included in the deprivation analysis and 62 patients were included in the HbA1c analysis and correlation analysis. Data was grouped based on 30-day mortality, 1 year mortality and survival past 1 year and the Mann Whitney test was used to analyse if there was a statistically significant difference in the index of multiple deprivation and HbA1c readings between groups. A Pearson correlation was used to analyse the correlation between the index of multiple deprivation and HbA1c.

Results: No statistically significant difference in the index of multiple deprivation or HbA1c was found between those who died at 30 days, 1 year or survived past 1 year. No statistically significant connection was found between IMD and HbA1c.

Conclusion(s): These results suggest that HbA1c and deprivation do not affect mortality in T2DM hemiarthroplasty hip fracture patients who are over 65 but more investigation is required. Furthermore, the results suggest that being more deprived does not lead to worse HbA1c control.

Impact: Both in inpatient (acute and rehabilitation settings) as well as outpatient settings, fragility hip fracture patients or those at risk of fragility fractures with diabetes are seen frequently seen, often on a daily basis. Yet our understanding of what leads to an increased risk of mortality post hip fracture, in this complex ageing population which we encounter and treat is limited.

This study provides a more nuanced understanding of the influence of deprivation on mortality post hip fracture in those with type 2 diabetes, providing more up to date evidence from the north west of England within the diabetic population.

The study of HbA1c also provides evidence where limited research has been completed previously, suggesting that HbA1c does not influence mortality in this increasingly prevalent (yet understudied) population.

Finally, it suggests that factors other than HbA1c and deprivation may be more influential on mortality post fracture, indicating that more research is required within this field.