Abstract
Introduction
There is a high prevalence of diabetes in patient populations undergoing Vascular Surgery. Appropriate and responsive management of diabetes in the perioperative setting is critical for reducing morbidity and perioperative complications e.g. diabetic emergencies, poor wound healing, delirium. The aim of this project was to review current practice for perioperative management of older people with diabetes against guidance outlined by the Centre for Perioperative Care (CPOC) on a regional vascular surgery ward.
Methods
A retrospective observational evaluation design was conducted from May-June 2024. Data were collected for patients all aged >60years with a pre-admission diagnosis of diabetes admitted to the ward in this period. Standards of care were derived from CPOC guidance. Data were collated and analysed using descriptive statistics.
Results
28 patients were included (20 male, 8 female). The mean age was 72 years. 86% (n=24) had Type 2 Diabetes and the remainder had Type 1. 82% (n=23) were emergency admissions and 93% (n=26) had surgery at some point in their admission. Only 38% (n=10) were prioritised as first patient on operating lists. There was mixed concordance with guidance on administration of oral diabetes medication perioperatively. However, all patients on SGLT2 inhibitors had these withheld appropriately. There was inconsistency in the frequency of capillary blood glucose (CBG) monitoring with variable responses to episodes of hypo and hyper-glycaemia and variable rate insulin prescriptions were not consistently utilised when indicated.
Discussion
This study has highlighted several areas for improvement of the perioperative management of diabetes in older vascular patients. The next stage of this work will involve a multi-component quality improvement initiative to provide education and support for all healthcare professionals involved in caring for this patient group.