A multinational online survey on the current perioperative practice for the management of patients with diabetes mellitus: a descriptive study

Background & Objective: Diabetes mellitus is widely prevalent and significantly impacts the perioperative outcome. We aimed to assess the perioperative practice for managing diabetes mellitus patients and variation across different establishments. Methodology: A questionnaire-based online survey was conducted for the present cross-sectional, multinational study; data collection followed a snowball method and was conducted from November 2020 to January 2021. Responses were presented in absolute number and percentage scale, and response rates among the subgroups were analyzed using Fisher's exact test; p < 0.05 was considered significant. Results: Responses from 556 out of 637 from six South Asian Association for Regional Cooperation countries were analyzed. A considerable amount of practice variation was noted; variation increased as the invasiveness of surgery increased. Perioperative insulin administration strategy and case postponement based on blood sugar level differed between the teaching and non-teaching sectors and private and public sectors. However, a majority (64.8%) of the respondents did not favor postponing a case based on the glycosylated hemoglobin (HbA1c) level. Confusion and diverse opinions were present even for emergency cases, including postponement based on blood sugar. Conclusion: There is a wide variation in the perioperative practice for managing diabetes mellitus patients. The variation increases with the increasing invasiveness of surgery. Although there were similar practices between private versus public sectors and teaching versus non-teaching institutions, significant differences were noticed about case postponement, indicating that an authoritative guideline is the need of the hour.