417 Improving Peri-Operative Management of the Acute Diabetic Vascular Patient

Aim Vascular patients are a high acuity cohort of patients with a high prevalence of diabetes. It’s well established that poor diabetic control is implicated in higher incidence of wound infections/systemic infection and poor healing amongst other sequalae. Many trusts have established guidelines for the peri-operative care of diabetics undergoing surgery and we sought to investigate our departmental compliance. Method Over a prospective 30-day period (18/9/23-19/10/23) patients admitted under the acute vascular take or pre-operative for expedited procedures were included. Patient notes and drug charts were reviewed looking for compliance with peri-operative diabetic guidance as well as blood glucose(BM) control. Results All 28 patients were type 2 diabetics, fourteen of which were on insulin regimes. Adherence to guidance was 50%, identified issues included background insulin stopped (N:5,18%), SGLT inhibitor not stopped (N:9,32%), Sliding scale not prescribed where indicated (N:3,11%). BM levels were on average higher in those for whom trust guidance was not followed 11.2mmol/L vs 8.6mmol/L with increased BM lability in the 24hr post-operative particularly in those whose background insulin should’ve been continued or sliding scale been prescribed (10.3mmol/L average difference between lowest and highest reading). Conclusions Our results highlight improvements required in adherence to trust guidance especially given the implications of poor BM control as established in the literature. We aim to build upon these findings having sent out a questionnaire to investigate the root causes as well as working on building a decision-based app to enable juniors to make timely correct decisions regarding diabetic peri-operative care.