This document is an abridged and modified version of Management of Adults with Diabetes Undergoing Surgery and Elective Procedures: Improving Standards. It has been adapted specifically for Diabetic Medicine.This article [NHS Diabetes guideline for the perioperative management of the adult patient with diabetes] was written by [K. Dhatariya, N. Levy, A. Kilvert, B. Watson, D. Cousins, D. Flanagan, L. Hilton, C. Jairam, K. Leyden, A. Lipp, D. Lobo, M. Sinclair-Hammersley and G. Rayman] of NHS UK. It is published with the permission of the Controller of HMSO and the Queens Printer for Scotland.
Diabetes UK Position Statements and Care Recommendations
NHS Diabetes guideline for the perioperative management of the adult patient with diabetes*
Article first published online: 12 MAR 2012
© 2012 Crown copyright. Diabetic Medicine © 2012 Diabetes UK
Volume 29, Issue 4, pages 420–433, April 2012
How to Cite
Dhatariya, K., Levy, N., Kilvert, A., Watson, B., Cousins, D., Flanagan, D., Hilton, L., Jairam, C., Leyden, K., Lipp, A., Lobo, D., Sinclair-Hammersley, M., Rayman, G. and for the Joint British Diabetes Societies (2012), NHS Diabetes guideline for the perioperative management of the adult patient with diabetes. Diabetic Medicine, 29: 420–433. doi: 10.1111/j.1464-5491.2012.03582.x
- Issue published online: 12 MAR 2012
- Article first published online: 12 MAR 2012
- Accepted manuscript online: 31 JAN 2012 01:06AM EST
- Accepted 11 January 2012
- perioperative management;
- variable rate intravenous insulin infusion
Diabet. Med. 29, 420–433 (2012)
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.