Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

The RMH Pro-Diab Perioperative Study: a structured perioperative diabetes management plan improves medication usage and glycaemia (#248)

Qi Yang Damien Qi 1 , Elizabeth Pemberton 2 , Mervyn Kyi 3 , Peter G Colman 3 , Spiros Fourlanos 3
  1. Royal Melbourne Hospital Clinical School, University of Melbourne, Melbourne, Victoria, Australia
  2. Department of Pain and Anaesthesia, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  3. Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia

Background: The perioperative management of inpatients with diabetes is complex. Suboptimal glycaemia in the perioperative period is common, and associated with increased morbidity and mortality.

Aim: To determine the effect of a structured perioperative diabetes management plan (PDMP) on the appropriate recommendation, prescription, and administration of diabetes medications in the perioperative setting.

Methods: A multidisciplinary team developed a novel structured PDMP endorsed by the Departments of Diabetes & Endocrinology and Pain & Anaesthesia. This observational study consisted of pre- and post-intervention periods, where pre-intervention care for perioperative diabetes management (non-structured) was audited for 4 months (Feb-May 2016) and then re-audited for 4 months (Feb-May 2017) post-intervention (structured plan). The primary outcome measure was documentation of appropriate recommendation, prescription and administration of diabetes medications in the perioperative setting according to the PDMP. Secondary outcome measures included glucose monitoring practice and glycaemic measures.

Results: The pre- and post-intervention groups comprised 138 and 84 patients respectively, all of whom were seen in preadmissions clinic and the majority admitted on the procedure day. The two groups were not significantly different in their clinical characteristics (Table1). In the intervention group, the PDMP was completed correctly in 71% of patients. The appropriate recommendation, prescription, and administration of diabetes medications occurred in 63% of cases in the post-intervention group compared to 30% in the pre-intervention group (p<0.001, Table1). Appropriate glucose monitoring in the pre- and post-operative periods significantly increased in the post-intervention group (Table1). The post-intervention group also had significant improvements in glycaemia in the pre- and post-operative periods (Table1). These improvements were even greater in the subset of patients who had the PDMP completed correctly.

Conclusion: This novel structured perioperative diabetes management plan used in elective surgery significantly improved the appropriate recommendation, prescription and administration of diabetes medications, glucose monitoring, and glycaemia.

 

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