SummaryDiabetes affects 10–15% of the surgical population and patients with diabetes undergoing surgery have greater complication rates, mortality rates and length of hospital stay. Modern management of the surgical patient with diabetes focuses on: thorough pre‐operative assessment and optimisation of their diabetes (as defined by a HbA1c < 69 mmol.mol−1); deciding if the patient can be managed by simple manipulation of pre‐existing treatment during a short starvation period (maximum of one missed meal) rather than use of a variable‐rate intravenous insulin infusion; and safe use of the latter when it is the only option, for example in emergency patients, patients expected not to return to a normal diet immediately postoperatively, and patients with poorly controlled diabetes. In addition, it is imperative that communication amongst healthcare professionals and between them and the patient is accurate and well informed at all times. Most patients with diabetes have many years of experience of managing their own care. The purpose of this guideline is to provide detailed guidance on the peri‐operative management of the surgical patient with diabetes that is specific to anaesthetists and to ensure that all current national guidance is concordant.
There is mounting concern about the pressures experienced by University Departments of Anaesthesia, which, if lost, could threaten undergraduate peri-operative medicine teaching, development of critical appraisal skills among anaesthetists, and the future of coherent research programs. We have addressed these problems by establishing a foundation course in scientific methods and research techniques (the Cambridge SMART Course), complemented by competitive, fully funded, 12-month academic trainee attachments. Research conducted during academic attachments has been published and used to underpin substantive grant applications allowing work towards higher degrees. Following the attachment, a flexible scheme ensures safe reintroduction to clinical training. Research at consultant level is facilitated by encouraging applications for Clinician Scientist Fellowships, and by ensuring that the University Department champions, legitimises and validates the allocation of research time within the new consultant contract. We believe that these are important steps in safeguarding research and teaching in anaesthesia, critical care and peri-operative medicine. There has been much correspondence in the medical press recently about the state of academic medicine [1], and academic anaesthesia in particular [2][3][4]. It is generally agreed that the number and size of University Departments of Anaesthesia are under threat in the United Kingdom. While increased research productivity by NHS consultants means that the number of papers published in the specialty may be increasing, this does not compensate for the loss of an organised approach to developing our understanding of peri-operative physiology and pathophysiology through coherent and long-term programmes of research, and finding new ways to improve clinical outcomes.
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