Perioperative management of diabetes

Diabetes is a complex, chronic metabolic disorder affecting approximately 10% of the adult population worldwide (International Diabetes Federation, 2021) with the estimated number of adults with diabetes having more than tripled since 2000. This increase has largely been attributed to global urbanization and lifestyle changes. Over 323,000 operations take place in the UK each year in people with diabetes, 15% of all operative procedures (Centre for Perioperative Care). These patients are frequently elderly, have complex medical co-morbidities and present for both high-risk elective and emergency surgery. This multisystem disease poses a significant challenge to both anaesthesia and surgery with patients with diabetes demonstrating higher morbidity and mortality rates compared to their non-diabetic counterparts. It is crucial that good glycaemic control is maintained throughout the perioperative period as this has been shown to correlate with positive patient outcomes. It is well-recognized that a coordinated, multidisciplinary approach aimed at optimizing every point in the patient pathway from GP referral to post-discharge care is required to obtain the best outcomes for the surgical patient with diabetes. The anaesthetist has a key role in the perioperative diabetes multidisciplinary team. Patients themselves are well experienced in managing their own diabetes and should be involved in doing so whenever possible.