The Pro-Diab Perioperative Study—A Structured Perioperative Diabetes Management Plan Improves Medication Usage and Glycemia in Elective Surgery

Abstract

The perioperative management of diabetes inpatients is complex, often inconsistent and frequently results in suboptimal glycemia. We designed, implemented and evaluated a structured perioperative diabetes management plan (PDMP) on appropriate diabetes medication usage and glycemia in the perioperative period, in elective non-cardiac surgery patients. A multidisciplinary team developed and implemented a novel structured PDMP at our tertiary hospital. This observational study audited perioperative diabetes management over 4 months pre-implementation (non-structured care) and 4 months post-implementation (structured PDMP care). Primary outcome was appropriate use (documented recommendation, prescription and administration) of diabetes medications in the perioperative period. Secondary outcomes included blood glucose (BG) monitoring practice and glycemia. Pre- and post-implementation groups comprised 138 and 141 patients respectively, all of whom attended preadmission clinic and were admitted on the day of the procedure. The two groups were well matched in clinical characteristics. The PDMP was completed correctly in 107 (76%) patients in the post-implementation group. The appropriate use of diabetes medications increased from 30% to 72% between pre- and post-implementation groups (p<0.001). Appropriate BG monitoring also increased (25% vs. 51%, p<0.001). There was improvement in glycemia with post-implementation group having lower BG in the preoperative period (mean±sd: 10.2±4.6 vs. 8.8±3.9 mmol/L, p=0.001); postoperative period (10.4±3.5 vs. 9.3±3.6 mmol/L, p=0.002); and in the entire perioperative period (10.3±4.1 vs. 9.0±3.8 mmol/L, p<0.001). This practical, implementable and novel structured perioperative diabetes management plan for elective surgery patients significantly improved diabetes medication usage, BG monitoring, and glycemia in the perioperative period. Disclosure Q. Qi: None. E.J. Pemberton: None. M. Kyi: None. P.G. Colman: None. S. Fourlanos: None.