Peri-operative management of diabetes mellitus: a multidisciplinary consensus statement from the Association of Anaesthetists and the Joint British Diabetes Societies for Inpatient Care group.
| Title: | Peri-operative management of diabetes mellitus: a multidisciplinary consensus statement from the Association of Anaesthetists and the Joint British Diabetes Societies for Inpatient Care group. |
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| Authors: | Levy NA; Department of Anaesthesia and Perioperative Medicine, West Suffolk NHS Foundation Trust, Bury St Edmunds, Suffolk, UK.; El-Boghdadly K; Department of Anaesthesia and Perioperative Care, Guy's and St Thomas' NHS Foundation Trust, London, UK.; King's College London, London, UK.; Lobo DN; Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK.; Division of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Stubbs DJ; NIHR Advanced Fellow Perioperative Acute Critical, and Emergency Care Section, University of Cambridge, Cambridge, UK.; Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge, UK.; Avari P; Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK.; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.; Buggy D; Department of Anaesthesia, Mater Misericordiae University Hospital, School of Medicine, University College Dublin, Dublin, Ireland.; Frank C; Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK.; Howson K; James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK.; Moffett J; Patient representative, Kingussie, UK.; Morris E; Stockport NHS Foundation Trust, Stockport, UK.; Mustafa OG; Department of Diabetes, King's College Hospital, London, UK.; Centre for Education, Faculty of Life Sciences & Medicine, King's College London, London, UK.; Nash G; Patient representative, Teynham, UK.; Scanaill PÓ; Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland.; Procter S; Department of Anaesthesia, East Suffolk North Essex NHS Foundation Trust, Ipswich, UK.; Rayman G; Department of Diabetes, East Suffolk North Essex NHS Foundation Trust, Ipswich, UK.; University of East Anglia Medical School, Norwich, UK.; Russon K; Department of Anaesthesia, Rotherham NHS Foundation Trust, Rotherham, UK.; Thomas C; Department of Anaesthesia, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.; Tinsley S; University Hospitals of North Midlands, Stoke on Trent, UK.; Xu A; Core Trainee in Anaesthesia, London School of Anaesthesia, London, UK.; Dhatariya K; University of East Anglia Medical School, Norwich, UK.; Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK. |
| Source: | Anaesthesia [Anaesthesia] 2026 Feb 16. Date of Electronic Publication: 2026 Feb 16. |
| Publication Model: | Ahead of Print |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 0370524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2044 (Electronic) Linking ISSN: 00032409 NLM ISO Abbreviation: Anaesthesia Subsets: MEDLINE |
| Imprint Name(s): | Publication: Oxford, UK : Wiley-Blackwell; Original Publication: London, Academic Press; New York, Grune & Stratton. |
| Abstract: | Introduction: Surgery in patients with diabetes mellitus is associated with increased morbidity and mortality compared with those who do not have diabetes mellitus. This is likely multifactorial and could be attributed to organisational issues; dysglycaemia; hospital-acquired diabetic ketoacidosis; errors with insulin prescribing and administration; issues with fluids and electrolytes; and systemic and surgical site infections. There was a need to update guidance for the peri-operative management of diabetes mellitus given improvements in our understanding, introduction of novel drugs and development of wearable technologies.; Methods: This was a multidisciplinary consensus statement with a diverse authorship group, including diabetologists; anaesthetists; surgeons; pharmacists; surgical diabetes inpatient specialist nurses; and patients with lived experience. We undertook a directed literature search and a three-round Delphi process to develop, refine and agree recommendations.; Results: Following three rounds, 38 recommendations were included, spanning all phases of the peri-operative pathway. Recommendations were made for organisations and general principles for the management of patients with diabetes, aiming to improve pathways, implement protocols and support training. We prioritise individualised care plans, encourage clinical judgement regarding proceeding with surgery with out-of-range HbA1c concentrations and recommend ensuring appropriate insulin regimens are prescribed and administered. We also provide guidance for capillary blood glucose and ketone monitoring and management; safe handovers of care; and multidisciplinary care plans for the peri-operative use of wearables.; Discussion: This consensus statement provides principles to be applied throughout the entire peri-operative pathway by healthcare professionals, institutions and patients. It is hoped that the implementation of these key recommendations will improve experience and outcomes for patients with diabetes mellitus having surgery.; (© 2026 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.) |
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| Contributed Indexing: | Keywords: diabetes mellitus; insulin; peri‐operative; safety; surgery; Local Abstract: [plain-language-summary] Medical experts developed these guidelines to help healthcare teams care for patients with diabetes who need surgery. These guidelines were created by a group of specialists from the UK and Ireland who used research methods to find and rank the most important recommendations. [plain-language-summary] Diabetes mellitus is a common condition that affects how the body manages blood sugar. Even though one out of every 13 people has diabetes, this can be as high as two out of five patients in the hospital. Research has shown that patients with diabetes who have surgery face higher risks of complications during and after their procedures. These complications can happen for many different reasons, including problems with blood sugar control, issues with insulin medicines, difficulties managing fluids and salts in the body, and increased risk of infections. [plain-language-summary] We made several recommendations, like creating an individualised care plan for each patient that covers their entire surgical experience and continuing their regular diabetes medicines whenever it is safe to do so, instead of switching to insulin given through a vein. The guidelines also focus on preventing blood sugar levels from becoming too high or too low. These guidelines also include up‐to‐date recommendations about using modern diabetes technology, like wearable devices that can monitor blood sugar levels continuously. It is hoped that these guidelines will improve the care of people with diabetes needing surgery. |
| Entry Date(s): | Date Created: 20260216 Latest Revision: 20260216 |
| Update Code: | 20260216 |
| DOI: | 10.1111/anae.70181 |
| PMID: | 41696887 |
| Database: | MEDLINE |
Journal Article