Diabetes Perioperative Management — FRCA Final MCQ

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ModeratePreoperative AssessmentDiabetes Perioperative ManagementFRCA Final

A 66-year-old woman with type 2 diabetes and CKD stage 3b is being assessed before elective total knee replacement. Her HbA1c, measured 6 weeks ago, is 78 mmol/mol. According to current UK perioperative guidance, which HbA1c value is used as the pragmatic threshold above which preoperative glycaemic optimisation should be initiated, where clinically safe and practicable?

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Correct answer: E — 69 mmol/mol

Explanation lettering: B = shown as A · E = shown as B · A = shown as C · C = shown as E

C is correct. UK perioperative guidance uses HbA1c 69 mmol/mol (8.5%) as the pragmatic threshold above which intervention and optimisation should be considered before elective surgery. This patient’s HbA1c of 78 mmol/mol therefore warrants diabetes-team input, an individual perioperative plan and shared decision-making about surgical timing. It is not an absolute cancellation threshold: the benefits and feasibility of optimisation must be balanced against the consequences of delay. CKD increases her overall perioperative risk but does not alter this HbA1c threshold. An HbA1c of 48 mmol/mol is the diagnostic threshold for diabetes, not the perioperative threshold. Values of 58, 75 and 80 mmol/mol are not the recommended UK elective-surgery threshold.

Reference: Royal College of Anaesthetists, Perioperative Quality Improvement Programme Report 6: March 2024 to March 2025, section 'Achievement of preoperative glycaemic control', 2025. https://rcoa.ac.uk/sites/default/files/documents/2025-07/PQIP-Report2025_0.pdf