Overview of periprocedural management of adults with diabetes

In this topic, the term ‘procedure’ is used to refer to an operation or procedure, and only management of adults is covered. Follow local hospital protocols if available. Comprehensive guidelines for perioperative diabetes management for adults are available from the Australian Diabetes Society (ADS). Clinical practice guidelines for the periprocedural management of a child or adolescent with diabetes are available from The Royal Children’s Hospital.

Patients with diabetes have an increased risk of periprocedural morbidity and mortality, including a high risk of cardiovascular events occurring while in hospital. Hyperglycaemia after a procedure is associated with complications such as infection and poor wound healing; hypoglycaemia after a procedure has been associated with increased mortality.

Note: Screen for diabetes in high-risk patients before they have a procedure.

Screen patients at high risk of developing diabetes before they have an elective procedure to allow optimal diabetes management before the procedure. For information on high-risk patients and the AUSDRISK screening tool, see Screening for type 2 diabetes in asymptomatic adults.

Note: Assess and optimise the glycaemic profile before a patient with diabetes has a procedure, if possible.
Optimising the glycaemic profile periprocedurally has been shown to improve outcomes for patients with diabetes. If possible (eg for elective surgery), optimisation of the glycaemic profile should be considered at the time of referral for the procedure; this allows time to engage the patient and adjust diabetes treatment, and to seek specialist advice if required. Individualise glycaemic targets, aiming to avoid hypoglycaemia; for glycaemic targets, see Glycaemic targets for adults with type 1 diabetes for type 1 diabetes and Glycaemic targets for adults with type 2 diabetes for type 2 diabetes.

If the glycated haemoglobin (HbA1c) is more than 75 mmol/mol (9%), nonurgent elective procedures (eg hip or knee arthroplasty) should be delayed until the glycaemic profile is optimised.

Note: Delay nonurgent elective procedures until the glycaemic profile is optimised.

Optimisation of diabetes management includes screening for and managing complications of diabetes, such as:

  • optimising medical management of cardiovascular disease before procedures. For example, a baseline electrocardiogram (ECG) may provide evidence of previous cardiovascular events or show a prolonged QT interval (associated with diabetic neuropathy)
  • screening for diabetic kidney disease (see Screening for diabetic kidney disease). Kidney function can worsen periprocedurally.