A Multidisciplinary Perioperative Diabetes Optimisation Pathway: Glycaemic and Hospital Pathway Outcomes in a Prospective Cohort

Aims/Background: Suboptimal glycaemic control may delay surgery and increase perioperative risk, yet national guidance provides limited detail on how preoperative diabetes optimisation should be organised. This study evaluated a multidisciplinary perioperative diabetes optimisation pathway in a tertiary hospital.

Methods

This prospective single-centre cohort included 174 consecutive adults referred to The Queen Elizabeth Hospital Birmingham, United Kingdom, between 1 January and 31 December 2024, with glycated haemoglobin (HbA1c) >69 mmol/mol (>8.5%) before elective surgery. The pathway comprised diabetologist assessment, individualised treatment adjustment, diabetes specialist nurse follow-up, education, repeat HbA1c measurement and communication with surgical teams. Primary outcomes were change in HbA1c and achievement of HbA1c ≤69 mmol/mol (≤8.5%). Secondary outcomes included progression to surgery and factors associated with target achievement and follow-up HbA1c. Multivariable logistic and linear regression examined target achievement and follow-up HbA1c, respectively.