Clinical impact of serum hemoglobin A1c and insulin levels in terms of postoperative complications in the nondiabetic patients with non-small cell lung cancer

Background: Hemoglobin A1c and insulin levels are important parameters to indicate glucometabolic status of the patients. It is important to understand major changes in glycometabolic status so as to predict postoperative complications. In this study, we aim to assess the impact of serum hemoglobin A1c and insulin levels on postoperative morbidity in lung cancer patients.

Materials and Methods: Between 2018 and 2019, 100 consecutive nondiabetic patients who underwent lung resection via thoracotomy with the indication of NSCLC were included in the study. Preoperatively all patients routinely underwent computed tomography and positron emission tomography (PET/CT), cranial magnetic resonance imaging (MRI) and pulmonary function and DLCO (Diffusing Capacity for Carbon Monoxide) tests. Preoperatively blood HbA1c, and fasting insulin levels of all patients were measured. Age, gender, BMI, insulin, HbA1c levels and postoperative complications were evaluated.

Results: The higher incidence of postoperative complications was found to be related to patients with higher insulin (46.8 mIU/L vs 16.9 mIU/L, p=0.001) and HbA1c (6.22% vs 5.46%; p=0.001) levels compared with those with normal levels In patients who underwent redo surgery to treat hemorrhagic complications, higher insulin and HbA1c levels were observed (61 mIU/L, and 6.54 %, respectively , p=0.001). HbA1c and insulin levels were also higher in cases with prolonged air leak (44.7 mIU/L, and 6.25%, respectively; p=0.001). Bronchopleural fistula was observed in three patients with high insulin and HbA1c levels (60.3 mIU/L, and 6.23%, respectively; p=0.001).

Conclusion: Preoperative HbA1c and fasting insulin levels are important parameters to predict postoperative morbidity in lung cancer patients.