title: Perioperative glycaemic control in diabetic patients undergoing cataract surgery under local anaesthesia: a survey of practices of Singapore ophthalmologists and anaesthesiologists.
abstract: BACKGROUND
  Perioperative glycaemic control is an important aspect of clinical management in diabetic patients undergoing cataract surgery under local anaesthesia. While poor long-term glycaemic control has significant implications for surgery, perioperative hypoglycaemia or hyperglycaemia may also compromise patient safety and surgical outcomes. We aimed to survey ophthalmologists and anaesthesiologists on their approach and to identify the prevalent practice patterns in Singapore.
  
  
  METHODS
  This was a cross-sectional questionnaire-based survey conducted in four public hospitals in Singapore with established ophthalmology and anaesthesia units. Respondents were approached individually, and the self-administered questionnaires comprised questions related to practice patterns, clinical scenarios and awareness of pre-existing guidelines.
  
  
  RESULTS
  A total of 129 doctors responded to the questionnaire survey. 76 (58.9%) were from ophthalmology departments and 53 (41.1%) were from anaesthesia departments. The majority chose to withhold oral hypoglycaemic agents (82.9%) and/or insulin (69.8%), and keep the patient fasted preoperatively. A blood glucose level ≥ 17 mmol/L prompted 86.0%-93.8% of respondents to adopt a treat-and-defer strategy, while a level ≥ 23 mmol/L prompted 86.0%-96.9% of respondents to cancel the cataract surgery. The respondents were consistently more concerned about perioperative hyperglycaemia (n = 99, 76.7%) than intraoperative hypoglycaemia (n = 83, 64.3%).
  
  
  CONCLUSIONS
  The current study presented the prevalent practice patterns of ophthalmologists and anaesthesiologists in the perioperative management of diabetic patients undergoing cataract surgery in four public hospitals in Singapore. Further research in this field is required, and may be useful for the future formulation of formal guidelines and protocols.
authors.affiliation: Singapore National Eye Centre, Singapore.
authors.forename: Jyh Haur
authors.initials: JH
authors.lastname: Woo
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Wei Di
authors.initials: WD
authors.lastname: Ng
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Maaz Mohammad
authors.initials: MM
authors.lastname: Salah
authors.affiliation: Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore.
authors.forename: Kumari
authors.initials: K
authors.lastname: Neelam
authors.affiliation: Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore.|Singapore International Eye Cataract Retina Centre, Mount Elizabeth Medical Centre, National University of Singapore, Singapore.|Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Kah-Guan
authors.initials: KG
authors.lastname: Au Eong
authors.affiliation: Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore.
authors.forename: Chandra Mohan
authors.initials: CM
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000772:Anesthesia, Local / Q000379:methods*; D000072080:Anesthesiologists / Q000706:statistics & numerical data*; D001786:Blood Glucose / Q000032:analysis*; D002387:Cataract Extraction; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D000072163:Ophthalmologists / Q000706:statistics & numerical data*; D019990:Perioperative Care / Q000379:methods; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose
keywords: cataract; diabetes mellitus; glycaemic control; local anaesthesia