Editor - While strongly agreeing with Dr Flanagan's summary of enhancing perioperative diabetes management (Clin Med Feb 2011 pp 63-4), one feels that there is more to be said on the subject of surgical pre-assessment for elective surgical patients. Pragmatically, surgeons (and anaesthetists) should recognise the significance of subop-timally controlled diabetes prior to any intervention or procedure. The best, simplest test for this in the setting of the surgical pre-assessment clinic is the glycated haemoglobin (HbA_1c). Audits have shown that a significant number of patients with diabetes do not have their HbA_1c checked or recorded in the three months prior to surgery. A simple system of including
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