Structured, person-centred glycaemic optimisation before surgery: The Manchester IP3D experience

STUDY OBJECTIVE: To evaluate the impact of a diabetes specialist nurse (DSN)-led perioperative optimisation service on glycaemic control in adults undergoing elective surgery. DESIGN: Retrospective service evaluation. SETTING: Manchester Royal Infirmary (Manchester University NHS Foundation Trust), a large UK teaching hospital and regional specialist centre. PARTICIPANTS: 398 adults with diabetes (mean age 62.2 years; 76.3% type 2 diabetes) referred to the preoperative pathway between 2020 and 2024. INTERVENTIONS: A structured pathway involving DSN-led outpatient consultations, blood result monitoring, and targeted education to support self-management and guideline adherence. MAIN OUTCOME MEASURE(S): Change in HbA1c from referral to the perioperative period (within 12 weeks of surgery) and predictors of glycaemic improvement. RESULTS: Participants had a median baseline HbA1c of 75 mmol/mol. Over a median 16-week interval with two DSN contacts, HbA1c decreased by a median of 18 mmol/mol. Multivariable analysis identified higher baseline HbA1c (p < 0.001) and frequency of DSN contacts (p < 0.001) as independent predictors of improvement. Notably, medication intensification and diabetes technology use were not significantly associated with HbA1c reduction. CONCLUSIONS: A structured DSN-led pathway achieves clinically meaningful HbA1c reductions in high-risk surgical patients. These gains were associated with specialist engagement rather than complex medication adjustments, suggesting that focused education is a safe, effective strategy for perioperative optimisation that minimises pharmacological burden in the secondary care setting.