title: The impact of glycaemic variability on the surgical patient.
abstract: OBJECTIVE
  Diabetes is the most prevalent long-term metabolic condition and its incidence continues to increase unabated. Patients with diabetes are overrepresented in the surgical population. It has been well recognized that poor perioperative diabetes control is associated with poor surgical outcomes. The outcomes are worst for those people who were not recognized as having hyperglycaemia.
  
  
  RESULTS
  Recent work has shown that preoperative recognition of diabetes and good communication between the clinical teams at all stages of the patient pathway help to minimize the potential for errors, and improve glycaemic control. The stages of the patient journey start in primary care and end when the patient goes home. The early involvement of the diabetes specialist team is important if the glycated haemoglobin is more than 8.5%, and advice sought if the preoperative assessment team is not familiar with the drug regimens. To date the glycaemic targets for the perioperative period have remained uncertain, but recently a consensus is being reached to ensure glucose levels remain between 108 and180 mg/dl (6.0 and 10.0 mmol/l). There have been a number of ways to achieve these - primarily by manipulating the patients' usual diabetes medications, to also allow day of surgery admission.
  
  
  CONCLUSIONS
  glycaemic control remains an important consideration in the surgical patient.
authors.affiliation: aElsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk bDepartment of Anaesthesia, West Suffolk NHS Foundation Trust, Hardwick Lane, Bury St Edmunds, Suffolk cDepartment of Anaesthesia and Intensive Care Medicine, St. George's Hospital Medical School, London, UK.
authors.forename: Ketan
authors.initials: K
authors.lastname: Dhatariya
authors.forename: Nicholas
authors.initials: N
authors.lastname: Levy
authors.forename: George M
authors.initials: GM
authors.lastname: Hall
mesh_terms: D001786:Blood Glucose / Q000032:analysis / Q000187:drug effects; D016638:Critical Illness; D003920:Diabetes Mellitus / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D005947:Glucose / Q000627:therapeutic use; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D007003:Hypoglycemia / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015918:Infusion Pumps, Implantable; D007328:Insulin / Q000627:therapeutic use; D019990:Perioperative Care / Q000379:methods*; D020250:Postoperative Nausea and Vomiting / Q000097:blood / Q000150:complications / Q000188:drug therapy; D011189:Potassium Chloride / Q000627:therapeutic use; D013315:Stress, Psychological / Q000097:blood; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D005947:Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D011189:Potassium Chloride; C517652:hemoglobin A1c protein, human