Acute medicine – an alternative take (2)

摘要

Improving perioperative diabetescareEditor – While strongly agreeing with DrFlanagan’s summary of enhancing perioperativediabetes management (Clin Med Feb2011 pp 63–4), one feels that there is moreto be said on the subject of surgical preassessmentfor elective surgical patients.Pragmatically, surgeons (and anaesthetists)should recognise the significance of suboptimallycontrolled diabetes prior to anyintervention or procedure. The best, simplesttest for this in the setting of the surgicalpre-assessment clinic is the glycatedhaemoglobin (HbA1c). Audits have shownthat a significant number of patients withdiabetes do not have their HbA1c checked orrecorded in the three months prior tosurgery. A simple system of includingHbA1c in the pre-assessment checklistmeans there is scope for rapid, onwardreferral to the local diabetes multidisciplinaryteam for optimising their glycaemiccontrol. The global benefits; improvedshort- and long-term control, reduced surgicalcomplication and infection rates aswell as reduced length of stay because ofgreater glycaemic stability could all potentiallystem from this one consideration.