Endocrine Abstracts

Introduction: The management of diabetes during surgery in children is not evidence-based although the ISPAD has produced consensus guidelines.

Aims: To explore the variability of guidelines in three regional diabetes networks in South West and South Central England and to compare them to the current ISPAD 2009 Guidelines.

Methods: Within an audit of in-patient care, a copy of the surgical guidelines was requested from 27 paediatric diabetes centres. Care plans including timing of surgery, blood glucose (BG) target, insulin and fluid regimes were analysed.

Results: Twenty-two guidelines were submitted. 19/22 (86%) clearly split their guidelines into major, minor and emergency surgery. For major surgery, 77% gave clear information to admit a day before surgery but 68% did not advise about time of admission for minor surgery. All guidelines documented the importance of placing first on the surgical list. Only 5/22 (22%) used ISPAD BG target range (5–10 mmol/l), 4/22 did not mention a glucose target. 15/22 (68%) services instructed the usual dose of insulin the evening before. Almost all (21/22) gave advice for patients on multiple daily injections, 18/22 (82%) mentioned twice-daily insulin and only 4/22 (18%) mentioned three times daily insulin. 10/22 (45%) gave advice for patients on insulin pumps but only 2 followed ISPAD guidelines. 19/22 (86%) provided infusion rates for insulin; these range from 0.3 to 0.5 units/kg per h (ISPAD recommends 0.025 units/kg per h). Only 10/22 (45%) used 0.45% sodium chloride with 5% dextrose and potassium as the main fluid regime. 59% gave advice for Emergency surgery but only one service gave additional advice for children with T2DM.

Conclusion: In spite of availability of international guidelines, a large degree of variation still exists in many aspects of management. In particular, variation in insulin and fluid regimes is confusing. National guidelines should be standardised to improve care quality.