ArticleClinical medicine (London, England)2026
Structured, person-centred glycaemic optimisation before surgery: The Manchester IP3D experience.
Article in Clinical medicine (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
STUDY
objectiveTo evaluate the impact of a diabetes specialist nurse (DSN)-led perioperative optimisation service on glycaemic control in adults undergoing elective surgery.
designRetrospective service evaluation.
settingManchester Royal Infirmary (Manchester University NHS Foundation Trust), a large UK teaching hospital and regional specialist centre.
participants398 adults with diabetes (mean age 62.2 years; 76.3% type 2 diabetes) referred to the preoperative pathway between 2020 and 2024.
interventionsA 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.
resultsParticipants 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.
conclusionsA 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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