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Structured, person-centred glycaemic optimisation before surgery: The Manchester IP3D experience
Mohammed So Ahmed1, Mariyah Ahmed1, Adhithya Sankar2
1Diabetes, Endocrine and Metabolism Centre, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust/University of Manchester, Manchester, UK.
Clinical Medicine (London, England)
|July 7, 2026
Summary
Diabetes Specialist Nurse-led care significantly improved glycaemic control in surgical patients. Focused education and specialist engagement, not complex medication changes, drove HbA1c reductions, optimizing patient outcomes.
Area of Science:
- Endocrinology
- Diabetes Care
- Surgical Optimization
Background:
- Perioperative glycaemic control is crucial for surgical outcomes in diabetic patients.
- Existing pathways may not adequately address the complex needs of these individuals.
- Diabetes Specialist Nurses (DSNs) can play a vital role in optimizing patient care.
Purpose of the Study:
- To assess the effectiveness of a DSN-led perioperative optimization service.
- To evaluate the impact on glycaemic control (HbA1c) in adults undergoing elective surgery.
- To identify predictors of glycaemic improvement in this patient cohort.
Main Methods:
- Retrospective service evaluation at a UK teaching hospital.
- Inclusion of 398 adult patients with diabetes referred to a preoperative pathway.
- Analysis of HbA1c changes from referral to the perioperative period (within 12 weeks of surgery).
Main Results:
- Median baseline HbA1c was 75 mmol/mol, decreasing by 18 mmol/mol over a median 16 weeks.
- Higher baseline HbA1c and increased DSN contact frequency predicted greater HbA1c reduction.
- Medication intensification and diabetes technology use did not significantly impact HbA1c levels.
Conclusions:
- A structured DSN-led pathway effectively reduces HbA1c in high-risk surgical patients.
- Improvements are linked to specialist engagement and education, not solely medication adjustments.
- This approach offers a safe, effective strategy for perioperative optimization, minimizing pharmacological burden.
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