Guidelines to improve perioperative management of diabetes mellitus: an example of a successful quality initiative

Abstract

SUMMARY  Aim: Assess impact of perioperative care guidelines for patients with diabetes mellitus undergoing elective surgical procedures. Methods: Perioperative guidelines were developed, with key measures compared with a historical cohort. Results: The postguidelines implementation cohort (n = 303) had 326 surgeries compared with 254 in the historical cohort (n = 241). Hemoglobin A1c was measured in 80 versus 47% historically (p < 0.01); preoperative glucose monitoring was 95 versus 88% (p < 0.01); intraoperative glucose monitoring was 67 versus 29% (p < 0.01); and postanesthesia care unit data were unchanged (p = 0.11). Insulin use increased throughout perioperative care (p ≤ 0.04). Mean preoperative glucose was 130 versus 141 mg/dl (p < 0.01); and, for postanesthesia care, 152 versus 162 mg/dl (p = 0.01). Conclusion: Standards of care improve perioperative glucose monitoring, insulin use and possibly glucose control.