Endocrine Abstracts

Background: There are >35,000 children and young people (CYP) living with diabetes in the UK (NPDA 2024). The options to support management of diabetes is evolving and can make the surgical management of CYP a challenge. The North Central London (NCL) network developed standardized perioperative guidelines for managing Diabetes during surgery.

Aim: To assess adherence to local perioperative diabetes guidelines for patients with Diabetes undergoing surgery at GOSH.

Method: In 2022 GOSH introduced a perioperative plan field into the electronic health record to be completed at pre-assessment or on admission to GOSH. We retrospectively reviewed records from patients with a diabetes perioperative plan documented between 2022 and 2025. We assessed whether management aligned with guidelines and identified reasons for deviations.

Results: Of 92 patients with a perioperative plan, 86 (93.5%) underwent surgery. Preoperative HbA1c was documented in 54.7% of cases. Minor surgery (<90min) was performed in 53.5%, major surgery (>90min) in 45.3%, with one case (1.2%) undocumented. Of the patients admitted on CSII,36.9% had the surgical procedure in ‘manual mode’, 34.7% pump mode not stated, 28.2% on sliding scale. Of the patients admitted on MDI one required sliding scale. There were 11.6% intraoperative complications of which 60% were related to diabetes (hypoglycaemia). Guideline deviations were observed in 44.2% of cases:

• 28.9% lacked documentation regarding pump delivery mode

• 23.7% incomplete intraoperative BG monitoring

• 7.9% lacked prescription of diabetes medication

• 7.9% retained sensors intraoperatively

• 28.9% other

Postoperative complications occurred in 19.8% of cases, with 52.9% related to hypoglycaemia/ hyperglycaemia. Discharge was delayed in 15.1%, with 61.5% of delays due to diabetes.

Conclusion: Perioperative plans are consistently created by the Diabetes CNS team, yet documentation gaps and deviations from protocol persist. Improved multidisciplinary communication, adherence to guidelines, and documentation—particularly around pump/sensor management and BG monitoring—are essential to optimize perioperative diabetes care.

Reference NPDA: 1. Reference diabetes surgical guidelines