The positive impact of a multidisciplinary preoperative diabetes clinic on improving glycaemic management in adults undergoing elective noncardiac surgery

Aims To investigate the impact of a multidisciplinary preoperative diabetes clinic on glycaemic and clinical outcomes in adults undergoing elective noncardiac surgery. Methods Seventy‐nine adults scheduled for elective noncardiac surgery with haemoglobin A1c (HbA 1c ) levels ≥64 mmol/mol (8.0%) were prospectively recruited. Participants received regular preoperative consultations with a pharmacist, diabetes nurse and diabetologist. Changes in HbA 1c and serum fructosamine levels between baseline and the day of surgery were compared using a paired t ‐test and linear regression. Results Mean HbA 1c at baseline was 83 mmol/mol (9.7%). There was a significant reduction in HbA 1c levels measured on the day of surgery, with mean HbA 1c being 63 mmol/mol (7.9%), equating to a mean reduction of −21 mmol/mol (95% CI −24, −16, p < 0.001). Linear regression analysis identified a significant negative relationship between baseline HbA 1c and change in HbA 1c , whereby each 1% increase in baseline HbA 1c predicted a −0.759% decrease in day of surgery HbA 1c . Median baseline fructosamine level was 361 μmol/L, and the median reduction on the day of surgery was −53 μmol/L (IQR −87 to −26 μmol/L, p < 0.001). Fructosamine levels measured 4 weeks postsurgery showed no significant change compared with the day of surgery. Median length of stay was 2 days (IQR 1–5), and there was a low incidence of in‐hospital infections and readmissions in the cohort. Conclusions The multidisciplinary clinic was effective in improving participants' glycaemic control before elective noncardiac surgery. Individuals with the highest baseline HbA 1c levels had the greatest preoperative improvement. This study highlights the meaningful impact on glycaemic management that can be achieved in the preoperative period. Parts of this work were previously presented at the 13th Australasian Symposium of the Perioperative Medicine Special Interest Group in collaboration with Summit III and the Perioperative Quality Initiative (POQI), 22–24 November 2024, Melbourne, Australia.