A Multidisciplinary Perioperative Diabetes Optimisation Pathway: Glycaemic and Hospital Pathway Outcomes in a...

Suboptimal glycaemic control may delay surgery and increase perioperative risk, yet national guidance provides limited detail on how preoperative diabetes optimisation should be organised. This study evaluated a multidisciplinary perioperative diabetes optimisation pathway in a tertiary hospital.

This prospective single-centre cohort included 174 consecutive adults referred to The Queen Elizabeth Hospital Birmingham, United Kingdom, between 1 January and 31 December 2024, with glycated haemoglobin (HbA1c) >69 mmol/mol (>8.5%) before elective surgery. The pathway comprised diabetologist assessment, individualised treatment adjustment, diabetes specialist nurse follow-up, education, repeat HbA1c measurement and communication with surgical teams. Primary outcomes were change in HbA1c and achievement of HbA1c ≤69 mmol/mol (≤8.5%). Secondary outcomes included progression to surgery and factors associated with target achievement and follow-up HbA1c. Multivariable logistic and linear regression examined target achievement and follow-up HbA1c, respectively.

Paired data were available for 149/174 patients (85.6%). Mean HbA1c decreased from 96.2 ± 14.0 to 73.1 ± 14.1 mmol/mol, a reduction of 23.1 mmol/mol (2.1 percentage points; p < 0.001); 77/149 patients (51.7%) achieved the target. Higher baseline HbA1c was associated with lower odds of target achievement (odds ratio 0.96 per mmol/mol, 95% confidence interval 0.94-0.99; p = 0.006), although patients with the highest baseline values achieved the largest absolute reductions. After adjustment for baseline HbA1c and other covariates, each additional diabetes-team appointment was associated with a 0.58 mmol/mol lower follow-up HbA1c (95% confidence interval -0.98 to -0.18; p = 0.005). Overall, 124/174 patients (71.3%) proceeded to surgery.

Referral to the pathway was associated with substantial improvement in preoperative HbA1c; just over half of patients achieved the preoperative target and most proceeded to surgery. Baseline HbA1c identified patients less likely to reach the fixed target despite larger absolute reductions, while more frequent specialist contact was modestly associated with lower follow-up HbA1c. Coordinated specialist follow-up, including pragmatic basal insulin initiation and titration where clinically indicated, provides a reproducible hospital-based model for preoperative diabetes optimisation.