Insulin-dependent Diabetic patients should be screened for M
The association of malnutrition in the morbidly obese cohort has led to recommendations for preoperative screening before total joint arthroplasty (TJA). This study compared malnutrition risk between diabetic patients and morbidly obese patients undergoing TJA and investigated the association of malnutrition on 30-day postoperative TJA outcomes in the diabetic cohort.

Patients were stratified by BMI and diabetes, and outcomes were reported as two composite groups: Complications and infections in the 30-day postoperative period.

--Patients with insulin-dependent diabetes mellitus (IDDM) were at a high risk of being malnourished in both the morbidly obese and nonmorbidly obese populations.

--Patients with IDDM, but without morbid obesity, were 1.5x more often malnourished than morbidly obese patients without diabetes mellitus (9.9% versus 6.4%, respectively).

--In a multivariate analysis among patients with co-occurring diabetes and malnutrition, patients with IDDM were at greatest risk for postoperative complications and infection (odds ratio 2.081 and odds ratio 1.894).

Patients with IDDM are at high risk for malnutrition, and increased vigilance should be maintained in this cohort before TJA to optimize outcomes.