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

Background

Pancreatic surgery patients are at increased risk of new onset diabetes or worsening glycaemic control in pre-existing diabetes. Bankstown-Lidcombe hospital has a high turnover of pancreatic resections annually, and we have trialed early collaboration between surgical and diabetes management teams to improve quality of care, and correctly diagnose and manage new-onset diabetes.

Aims

To develop a guideline for the preoperative evaluation by a diabetes educator (DE) of all patients undergoing pancreatic surgery and to ensure all patients are assessed preoperatively for diabetes status with HbA1c.

Methods

A DE referral pathway was developed, however, referrals were inconsistently completed. Subsequently, a DE-CNC joined the Pancreatic Cancer Committee and after collaboration between the surgical team, pre-admission clinic and diabetes centre, all patients were to be referred preoperatively on attendance at pre-admission clinic. The guideline developed was commenced in mid-2016 and provides direction for care for all pancreatic surgery patients, regardless of diabetes status pre-operatively. Data have been collected on HbA1c, diabetes status and diabetes diagnosis at discharge.

Results

Following implementation of the guideline, twelve of thirteen patients were referred preoperatively compared to only one referral prior, and all patients were assessed with preoperative HbA1c compared to nil prior, with three new diabetes cases diagnosed preoperatively (Table 1).

Conclusions

A screening and management guideline for diabetes with early active involvement by a DE enhances the patient journey after pancreatic surgery. In particular, patients with a new diagnosis of diabetes or initiation of insulin therapy had already met a DE prior to surgery and were prepared for potential changes to management. Almost all patients were seen by the DE and had a plan for diabetes screening post-operatively or follow-up arranged for review of diabetes management in their local area. A partnership with another hospital is to commence to implement a similar guideline.