The rationale and the strategies to achieve perioperative glycaemic control

<span class="paragraphSection"><div class="boxedTextSection">Key points<ul><li class="bullet">Diabetes (DM) is the most common metabolic disorder. Diabetes leads to increased surgical morbidity, mortality and length of stay.</li><li class="bullet">Hyperglycaemia is associated with increased risk of infection, medical complications and death. Hypo glycaemia is associated with increased risk of death.</li><li class="bullet">Ideally, the elective patient should have a preoperative glycated haemoglobin <69mmol mol⁻¹ (8.5%). The ideal perioperative capillary blood glucose (CBG) should be between 6.0–10.0 mmol litre⁻¹ for all patients with diabetes.</li><li class="bullet">Perioperative glycaemic control has traditionally been maintained with the variable rate intravenous insulin infusion (VRIII). However, it is now recognised that the use of the variable rate intravenous insulin infusion (VRIII) is associated with complications, so strategies have been implemented to promote its safe use, as well as limiting its use.</li><li class="bullet">In the UK, it is recommended that perioperative glycaemic control is achieved by manipulation of the patients normal medication when possible. All elective and expedited patients should be seen in pre-assessment clinics to facilitate safe hospital admission.</li></ul></div></span>

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