Rationale:

• Because patients will not be eating, they can be prone to developing hypoglycemia; educating patients on early symptoms may prevent serious neuroglycopenia.
• Patients may be better prepared for surgery if they understand what their management plan will be and how they may be able to avoid serious complications.
• The preoperative medical assessment provides patients with an opportunity to have their diabetes management reviewed and an attempt to improve glycemic control.

Evidence:

• In a prospective cohort study of 280 patients with diabetes, those who received automated self-care assessment calls with nursing phone call follow-up had fewer symptoms of hypo- or hyperglycemia (P<0.001) (60).
• In a case-control study of 21 patients who had severe hypoglycemia, patients were found to have less knowledge about diabetes than those who did not experience severe hypoglycemia. The investigators concluded that patients' lack of knowledge about the symptoms and signs of hypoglycemia is strongly associated with development of hypoglycemia (61).
• A randomized, controlled trial of patients with HbA_1C levels >8.5% were randomly assigned to receive an intensive education program with structured curriculum or educational material. HbA_1C levels fell equally in both groups (-2.0%) at 12 months (P<0.001) (62).
• In a randomized, controlled trial of 170 patients with type 2 diabetes, patients were randomly assigned to either individual or group educational settings. Both groups in the study had similar improvements in knowledge, BMI, health-related quality of life and reduction in HbA_1C compared to baseline. HbA_1C level at baseline fell from 8.5% ± 1.8% to 6.5 ± 0.8% at 6 months (63).
• A technical review discusses the importance of diabetes self-management education for the hospitalized patient (49).

Comments:

• Patient education and perioperative management may be facilitated by a team approach including teaching competent adult patients about elements of self-management while hospitalized.