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

IF 3.9 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Clinical Medicine Pub Date : 2026-09-01 Epub Date: 2026-07-23 DOI:10.1016/j.clinme.2026.100619

Mohammed S O Ahmed, Mariyah Ahmed, Adhithya Sankar, Jacqueline Toombs, Hood Thabit

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引用次数: 0

Abstract

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.

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术前结构化，以人为中心的血糖优化：曼彻斯特IP3D经验。

研究目的：评价糖尿病专科护士（DSN）主导的围手术期优化服务对成人择期手术患者血糖控制的影响。设计：回顾性服务评价。环境：曼彻斯特皇家医院（曼彻斯特大学NHS基金会信托），一个大型的英国教学医院和区域专家中心。参与者：398名成人糖尿病患者（平均年龄62.2岁，76.3%为2型糖尿病），在2020年至2024年期间进行术前路径研究。干预措施：一个结构化的途径，包括dsn主导的门诊咨询，血液结果监测和有针对性的教育，以支持自我管理和指南的遵守。主要结局指标：HbA1c从转诊到围手术期（手术12周内）的变化和血糖改善的预测指标。结果：参与者的中位基线HbA1c为75mmol/mol。在两次DSN接触的中位数16周间隔内，HbA1c中位数下降了18mmol/mol。多变量分析发现，较高的基线HbA1c （p < 0.001）和DSN接触频率（p < 0.001）是改善的独立预测因素。值得注意的是，药物强化和糖尿病技术的使用与HbA1c降低没有显著相关。结论：一种结构化的dsn引导通路在高危外科患者中实现了具有临床意义的HbA1c降低。这些收益与专家参与有关，而不是复杂的药物调整，这表明重点教育是一种安全有效的围手术期优化策略，可以最大限度地减少二级护理环境中的药理学负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Medicine 医学-医学：内科

CiteScore

7.20

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Clinical Medicine is aimed at practising physicians in the UK and overseas and has relevance to all those managing or working within the healthcare sector. Available in print and online, the journal seeks to encourage high standards of medical care by promoting good clinical practice through original research, review and comment. The journal also includes a dedicated continuing medical education (CME) section in each issue. This presents the latest advances in a chosen specialty, with self-assessment questions at the end of each topic enabling CPD accreditation to be acquired. ISSN: 1470-2118 E-ISSN: 1473-4893 Frequency: 6 issues per year