title: Perioperative management of diabetes in elective patients: a region-wide audit.
abstract: BACKGROUND
  Ten percent of elective surgical patients have diabetes. These patients demonstrate excess perioperative morbidity and mortality. National guidance on the management of adults with diabetes undergoing surgery was published in 2011. We present a region-wide audit of adherence to this guidance across the North Western Deanery.
  
  
  METHODS
  Local teams prospectively collected data according to a locally approved protocol. Pregnant, paediatric and non-elective patients were excluded from this audit. Patient characteristics, type of surgery and aspects of perioperative management were collated and centrally analysed against audit criteria based upon national recommendations.
  
  
  RESULTS
  247 patients with diabetes were identified. HbA1c was recorded in 71% of patients preoperatively; 9% of patients with an abnormal HbA1c were not known by, or referred to, the diabetes team. 17% of patients were admitted the evening preceding surgery. The mean fasting time was 12:20(4) h. Variable rate i.v. insulin infusions (VRIII) were not used when indicated in 11%. Only 8% of patients received the recommended substrate fluid, along with the VRIII (5% glucose in 0.45% saline). Intra-operative capillary blood glucose (CBG) was measured hourly in 56% of patients. Intra-operative CBG was within the acceptable range (4-12 mmol.L(-1)) in 85% of patients. 73% of patients had a CBG measurement performed in recovery. The WHO checklist was used in 95% of patients.
  
  
  CONCLUSIONS
  National perioperative guidelines were not adhered to in a substantial proportion of patients with diabetes undergoing elective surgery. This study represents a template for future trainee networks.
authors.affiliation: Department of Anaesthesia and Intensive Care, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK m.j.jackson@doctors.org.uk.
authors.forename: M J
authors.initials: MJ
authors.lastname: Jackson
authors.affiliation: Department of Anaesthesia and Intensive Care, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
authors.forename: C
authors.initials: C
authors.lastname: Patvardhan
authors.affiliation: Department of Anaesthesia and Intensive Care, Royal Preston Hospital, Sharoe Green Lane, Preston PR2 9HT, UK.
authors.forename: F
authors.initials: F
authors.lastname: Wallace
authors.affiliation: Department of Anaesthesia and Intensive Care, Royal Preston Hospital, Sharoe Green Lane, Preston PR2 9HT, UK.
authors.forename: A
authors.initials: A
authors.lastname: Martin
authors.affiliation: Department of Anaesthesia and Intensive Care, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD.
authors.forename: H
authors.initials: H
authors.lastname: Yusuff
authors.affiliation: Department of Anaesthesia, University Hospital South Manchester, Southmoor Road, Manchester M23 9LT, UK.
authors.forename: G
authors.initials: G
authors.lastname: Briggs
authors.affiliation: Centre for Endocrinology and Diabetes, Institute of Human Development, Manchester Royal Infirmary and University of Manchester, Oxford Road, Manchester M13 9WL, UK Weill Cornell Medical College, Education City, Qatar Foundation, Qatar.
authors.forename: R A
authors.initials: RA
authors.lastname: Malik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000628:therapy*; D017558:Elective Surgical Procedures; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019990:Perioperative Care / Q000379:methods / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D006113:United Kingdom; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: anaesthesia; clinical audit; diabetes mellitus; perioperative care; surgical procedures, elective