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What Does the Research Say?
Diabetes and Shoulder Replacement: What Every Clinician Should Know
15-25%
of patients undergoing shoulder arthroplasty have diabetes. They face significantly increased risks for infection, readmission, respiratory complications, and deep vein thrombosis, even after controlling for other comorbidities.
Key Finding
Glycemic Control: What the Evidence Actually Says
A 2024 single-center study found no significant differences in complications between controlled diabetes (hemoglobin A1c below 7.0%) and nondiabetic patients. The key factor isn't having diabetes. It's whether diabetes is well-managed.
Optimal hemoglobin A1c threshold is likely 7.5 to 8.0% based on available evidence.
90-Day Readmission Risk
↑
Significantly increased for diabetic patients
2023 study, 113,000+ patients
Controlled Diabetes Complication Risk
0
No significant increase when hemoglobin A1c is below 7.0%
HbA1c Target
7.5-8.0%
Optimal threshold extrapolated from lower extremity arthroplasty data
Wound Assessment
✓
Required at every therapy visit for diabetic patients
3 Takeaways for Your Practice
1
Wound Surveillance
Check the Incision at Every Single Visit
Diabetic patients have impaired wound healing and increased infection susceptibility. Look for erythema, warmth, drainage, or dehiscence. Do not assume healing is on track without visual confirmation every session.
2
Glycemic Coordination
Partner with the Patient's Medical Team
Hyperglycemia during the immediate postoperative period impairs wound healing and raises infection risk. Coordinate with endocrinology or primary care to monitor and optimize blood sugar throughout recovery.
3
Individualized Progression
Base Advancement on Healing, Not on the Calendar
Progression through phases should be based on wound healing status and absence of complications, not rigid time-based milestones. Controlled diabetic patients may progress normally. Poorly controlled patients need more time.
Product Spotlight:
Total Shoulder Arthroplasty: Evidence-Based Update
$37.97
This advanced continuing education course provides an up-to-date, evidence-based overview of rehabilitation and complication management after anatomic and reverse total shoulder arthroplasty (TSA). Using current research and clinical guidelines, the course reviews surgical indications, compares outcomes of anatomic vs. reverse… read more
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Meet the Author: Anne Osborn, PT, MPT
Anne Perry Osborn is a distinguished physical therapist and entrepreneur with over two decades of experience bridging clinical practice and healthcare education. She holds a Master of Physical Therapy from Texas Tech University Health Sciences Center and currently serves as the Owner and Director of Quality and Accreditation at Ridley Learning. With a background that includes clinical roles in outpatient rehabilitation and home health, Anne brings practical, hands-on insight to her leadership in continuing education, ensuring that learning opportunities remain relevant and impactful for today's practitioners.
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