The Pro-Diab Melbourne Perioperative Study: A structured pre-admission perioperative diabetes management plan to improve medication usage in elective surgery

Background Perioperative diabetes management has become increasingly complex; management is often inconsistent resulting in dysglycaemia and associated morbidity. Aim To evaluate a structured pre-admission perioperative diabetes management plan (PDMP) for safe and appropriate recommendation, prescription and administration of diabetes medications in the perioperative period for people with diabetes undergoing elective, non-cardiac surgery. Methods A multidisciplinary team developed the intervention, a structured PDMP (including diabetes medication reconciliation, management guide, individualised plan) to standardise optimal perioperative diabetes management. A single centre prospective pre- and post-intervention pilot study was performed, including all individuals with diabetes medications attending the pre-admissions clinic during two 4-month periods (February to May) in 2016 (control period) and 2017 (intervention period). The primary outcome was appropriate recommendation, prescription and administration of diabetes medications (including insulin), according to the PDMP, in the perioperative period. Secondary outcomes measures were glycaemia. Analysis was by intention to treat. Results Control and intervention groups included 131 and 133 participants, respectively; they were well matched in clinical characteristics. The PDMP was completed correctly in 100 (75%) individuals in the intervention group. The appropriate use of diabetes medications increased from 30% in the control group to 71% in the intervention group (p < 0.001). Following the PDMP implementations, glycaemia improved in the overall perioperative period (8.7 +/- 2.9 vs. 9.8 +/- 3.3 mmol/L, p = 0.005) and at all time points (from admission and over entire hospital stay). Conclusion A structured pre-admission perioperative diabetes management plan for elective surgery improved safe and appropriate diabetes medication use and glycaemia in the perioperative period.