Airway Assessment and Predicting Difficult Airway in Diabetic Patients Versus Non-Diabetic Patients

Background: Diabetes mellitus is associated with non-enzymatic glycosylation of connective tissue proteins, resulting in limited joint mobility and reduced cervical spine movement, which may increase the risk of difficult airway management during anesthesia. The aim is to assess airway parameters and predict difficult airway in diabetic versus non-diabetic patients undergoing elective surgery under general anesthesia. Material and Methods: This prospective observational study was conducted in the Department of Anaesthesia and Critical Care, VIMSAR, Burla, Odisha, from January 2024 to December 2025. A total of 150 patients aged 40–70 years were enrolled, including 75 diabetic and 75 non-diabetic patients. Airway assessment was performed using Modified Mallampati Grade, Thyromental Distance (TMD), Palm Print Sign, Degree of Head Extension (DHE), Prayer Sign, and Cormack–Lehane grading. Hemodynamic parameters including heart rate, blood pressure, and oxygen saturation were also recorded. Statistical analysis was performed using appropriate tests, and p<0.05 was considered significant. Results: Baseline demographic characteristics were comparable between the groups. Diabetic patients had significantly higher fasting blood sugar, post-prandial blood sugar, and HbA1c levels (p<0.001). Restricted head extension was significantly more common among diabetic patients (16.0% vs. 2.7%; p=0.036), with an odds ratio of 6.95 (95% CI: 1.45–32.25; p=0.009). Abnormal palm print grading was also significantly higher in diabetics (42.7% vs. 25.3%; p=0.007), with an odds ratio of 2.19 (95% CI: 1.10–4.39; p=0.038). Other airway parameters showed no statistically significant differences. No individual airway assessment test demonstrated high diagnostic accuracy for predicting difficult laryngoscopy. Conclusion: Diabetic patients exhibit a higher prevalence of airway abnormalities, particularly restricted head extension and abnormal palm print sign. Combined airway assessment incorporating joint mobility evaluation may improve identification of potentially difficult airways in diabetic patients.

Keywords: Diabetes mellitus, Difficult airway, Airway assessment, Mallampati grade, Palm print sign, Prayer sign, Head extension, Difficult laryngoscopy, Thyromental distance, General anesthesia.