Guidelines to improve perioperative management of diabetes mellitus: Assessment of the impact of change across time

Objective: Assess the impact of guidelines on the care of patients with diabetes undergoing elective surgery. Methods: A multidisciplinary team developed perioperative guidelines. Overall changes in key measures were evaluated after guidelines were introduced and compared with a historical cohort. Results: The historical cohort included 254 surgical procedures, and the post-guidelines implementation cohort comprised 1,387. Glucose monitoring was performed preoperatively in 93% of cases in the post-guidelines implementation cohort and in 88% in the historical cohort (P<.01), but the percentage of cases with measurements decreased over 12 months (from 95% to 91%, P =.044). Glucose was intraoperatively monitored in 67% of cases after guidelines were introduced and in 29% historically (P<.01); the post-guidelines implementation percentage decreased over 12 months from 67% to 55% (P<.01). The performance of glucose monitoring in the postanesthesia care unit (PACU) did not differ (86% vs. 87%, P =.57), but it decreased over 12 months, from 91% to 84% (P<.01). After introduction of the guidelines, insulin use increased in the preoperative, intraoperative, and PACU areas (all P≤.01) but decreased by the end of 12 months (all P<.01). Mean preoperative and PACU glucose levels in the post- guidelines implementation cohort were significantly lower than in the historical cohort (P<.01). Conclusion: Multidisciplinary management guidelines for diabetes patients undergoing surgery can improve the performance of key measures of care. Although adherence to recommendations generally remained higher after guideline implementation than in the historical period, the improvement in several measures began to decline over time.