The prevalence of diabetes is rising and so too is the complexity of diabetes management. There is an increasing number of diabetes medication classes and of medications within each of the classes including combination medications as well as rising uptake of diabetes technology which is also rapidly advancing.
20-30% of surgical patients have known diabetes or have undiagnosed diabetes or pre-diabetes in whom stress hyperglycaemia may occur in the peri-operative and peri-procedural setting. Whether known diabetes or stress hyperglycaemia it has been shown that optimal glycaemic control improves surgical outcomes and reduces length of hospital stay.
In addition, the length of hospital stay before and after surgery has markedly shortened leading to greater pressure on pre-operative assessment of diabetes and management plans that need individual tailoring, as well as arrangements for postoperative diabetes care.
Modern perioperative management of patients with diabetes focuses on thorough pre-operative assessment and optimisation of their diabetes. Most people with diabetes are managed in primary care settings and anaesthetists are increasingly needing to take on the burden of ensuring optimal glycaemic assessment and management
The 2022 ADS-ANZCA guidelines have been co-developed therefore by both diabetes and anaesthetist specialists with particular focus for anaesthetists but also for primary care and diabetes health care providers in order to guide optimal assessment, management and support for people living with diabetes. There has been broad consultation during their development and it is anticipated that review and updates are likely to be needed every 5 years.
These guidelines cover but are not limited to:
- Referral from primary care and planning surgery
- Information regarding diabetes risk assessment, diabetes medications and complications in context of the perioperative setting
- Intra-operative care and monitoring
- Fluid management
- Returning to ‘normal’ (pre-operative) medication and diet
- Sample templates for referral or patient information
ADS-ANZCA Perioperative Diabetes and Hyperglycaemia Guidelines (Adults)Download the updated ADS-ANZCA Perioperative Diabetes and Hyperglycaemia Guidelines Adults – PDF
