Peri-operative management of the surgical patient with diabetes: a guideline summary

Background: Diabetes significantly increases the risk of morbidity and mortality associated with surgery. These guidelines target anesthetists, providing guidelines for management of the diabetic patients in the pre-operative, peri-operative and post-operative periods. Methods: The following paper summarizes the Association of Anaesthetists of Great Britain and Ireland clinical guidelines on peri-operative management of the surgical patients with diabetes 2015. Results: It is recommended that where possible all diabetic patients achieve an HbA1c less than 69 mmol/mol (8.5%) prior to surgery. On the day of surgery, fasting periods should be limited to one meal and if this is not possible, a variable-rate intravenous insulin infusion should be started. Intra-operatively blood glucose should remain between 6 and 10 mmol/L. Post-operatively, the key to resuming normal diabetic management is through returning to an normal diet as soon as possible. Conclusions: The aim of management of a diabetic patient during the operative period is to maintain normal blood glucose levels (6 - 10 mmol/L). This is achieved through careful pre-operative planning, appropriate management of blood glucose levels and fluid balance intra-operatively and a smooth transition to resume the patients normal diabetic management