• Ketan Dhatariya, Nicholas Levy, and George M Hall.
• aElsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk bDepartment of Anaesthesia, West Suffolk NHS Foundation Trust, Hardwick Lane, Bury St Edmunds, Suffolk cDepartment of Anaesthesia and Intensive Care Medicine, St. George's Hospital Medical School, London, UK.
• Curr Opin Anaesthesiol. 2016 Jun 1; 29 (3): 430437430-7.

Purpose Of ReviewDiabetes is the most prevalent long-term metabolic condition and its incidence continues to increase unabated. Patients with diabetes are overrepresented in the surgical population. It has been well recognized that poor perioperative diabetes control is associated with poor surgical outcomes. The outcomes are worst for those people who were not recognized as having hyperglycaemia.Recent FindingsRecent work has shown that preoperative recognition of diabetes and good communication between the clinical teams at all stages of the patient pathway help to minimize the potential for errors, and improve glycaemic control. The stages of the patient journey start in primary care and end when the patient goes home. The early involvement of the diabetes specialist team is important if the glycated haemoglobin is more than 8.5%, and advice sought if the preoperative assessment team is not familiar with the drug regimens. To date the glycaemic targets for the perioperative period have remained uncertain, but recently a consensus is being reached to ensure glucose levels remain between 108 and180 mg/dl (6.0 and 10.0 mmol/l). There have been a number of ways to achieve these - primarily by manipulating the patients' usual diabetes medications, to also allow day of surgery admission.Summaryglycaemic control remains an important consideration in the surgical patient.

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