title: NHS Diabetes guideline for the perioperative management of the adult patient with diabetes.
abstract: These Joint British Diabetes Societies guidelines, commissioned by NHS Diabetes, for the perioperative management of the adult patient undergoing surgery are available in full in the Supporting Information. This document goes through the seven stages of the patient journey when having surgery. These are: primary care referral; surgical outpatients; preoperative assessment; hospital admission; surgery; post-operative care; discharge. Each stage is given its own considerations, outlining the roles and responsibilities of each group of healthcare professionals. The evidence base for the recommendations made at each stage, discussion of controversial areas and references are provided in the report. This document has two key recommendations. Firstly, that the management of the elective adult surgery patients should be with modification to their usual diabetes treatment if the fasting is minimized because the routine use of a variable rate intravenous insulin infusion is not recommended. Secondly, that poor preoperative glycaemic control leads to post-outcomes and thus, where appropriate, needs to be addressed prior to referral for surgery.
authors.affiliation: Norfolk and Norwich University Hospitals, Norwich, UK. ketan.dhatariya@nnuh.nhs.uk
authors.forename: K
authors.initials: K
authors.lastname: Dhatariya
authors.forename: N
authors.initials: N
authors.lastname: Levy
authors.forename: A
authors.initials: A
authors.lastname: Kilvert
authors.forename: B
authors.initials: B
authors.lastname: Watson
authors.forename: D
authors.initials: D
authors.lastname: Cousins
authors.forename: D
authors.initials: D
authors.lastname: Flanagan
authors.forename: L
authors.initials: L
authors.lastname: Hilton
authors.forename: C
authors.initials: C
authors.lastname: Jairam
authors.forename: K
authors.initials: K
authors.lastname: Leyden
authors.forename: A
authors.initials: A
authors.lastname: Lipp
authors.forename: D
authors.initials: D
authors.lastname: Lobo
authors.forename: M
authors.initials: M
authors.lastname: Sinclair-Hammersley
authors.forename: G
authors.initials: G
authors.lastname: Rayman
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000097:blood* / Q000188:drug therapy* / Q000628:therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy; D017558:Elective Surgical Procedures; D005215:Fasting; D005440:Fluid Therapy / Q000592:standards; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007430:Intraoperative Care / Q000592:standards; D010045:Outpatients; D010351:Patient Discharge; D019990:Perioperative Care / Q000379:methods / Q000592:standards*; D011182:Postoperative Care / Q000592:standards; D011300:Preoperative Care / Q000592:standards; D013514:Surgical Procedures, Operative; D006113:United Kingdom
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin