None of the trials examined the effects of the interventions in terms of costs .
AUTHORS ' CONCLUSIONS The included trials did not demonstrate significant differences for most of the outcomes when targeting intensive perioperative glycaemic control compared with conventional glycaemic control in patients with diabetes mellitus .
However , posthoc analysis indicated that intensive glycaemic control was associated with an increased number of patients experiencing hypoglycaemic episodes .
BACKGROUND Patients with diabetes mellitus are at increased risk of postoperative complications .
Data from r and omised clinical trials and meta-analyses point to a potential benefit of intensive glycaemic control , targeting near-normal blood glucose , in patients with hyperglycaemia ( with and without diabetes mellitus ) being su bmi tted to surgical procedures .
However , there is limited evidence concerning this question in patients with diabetes mellitus undergoing surgery .
OBJECTIVES To assess the effects of perioperative glycaemic control for diabetic patients undergoing surgery .
Continuous Perioperative Insulin Infusion Decreases Major Cardiovascular Events in Patients Undergoing Vascular Surgery: A Prospective, Randomized Trial
Background : A growing body of evidence suggests that hyperglycemia is an independent predictor of increased cardiovascular risk . Aggressive glycemic control in the intensive care decreases mortality . The benefit of glycemic control in noncardiac surgery is unknown . Methods : In a single-center , prospect i ve , unblinded , active-control study , 236 patients were r and omly assigned to continuous insulin infusion ( target glucose 100–150 mg/dl ) or to a st and ard intermittent insulin bolus ( treat glucose > 150 mg/dl ) in patients undergoing peripheral vascular bypass , abdominal aortic aneurysm repair , or below- or above-knee amputation . The treatments began at the start of surgery and continued for 48 h. The primary endpoint was a composite of all-cause death , myocardial infa rct ion , and acute congestive heart failure . The secondary endpoints were blood glucose concentrations , rates of hypoglycemia ( < 60 mg/dl ) and hyperglycemia ( > 150 mg/dl ) , graft failure or reintervention , wound infection , acute renal insufficiency , and duration of stay . Results : The groups were well balanced for baseline characteristics , except for older age in the intervention group . There was a significant reduction in primary endpoint ( 3.5 % ) in the intervention group compared with the control group ( 12.3 % ) ( relative risk , 0.29 ; 95 % confidence interval , 0.10–0.83 ; P = 0.013 ) . The secondary endpoints were similar . Hypoglycemia occurred in 8.8 % of the intervention group compared with 4.1 % of the control group ( P = 0.14 ) . Multivariate analysis demonstrated that continuous insulin infusion was a negative independent predictor ( odds ratio , 0.28 ; 95 % confidence interval , 0.09–0.87 ; P = 0.027 ) , whereas previous coronary artery disease was a positive predictor of adverse events . Conclusion : Continuous insulin infusion reduces perioperative myocardial infa rct ion after vascular surgery
None of the trials examined the effects of the interventions in terms of costs .
AUTHORS ' CONCLUSIONS The included trials did not demonstrate significant differences for most of the outcomes when targeting intensive perioperative glycaemic control compared with conventional glycaemic control in patients with diabetes mellitus .
However , posthoc analysis indicated that intensive glycaemic control was associated with an increased number of patients experiencing hypoglycaemic episodes .
BACKGROUND Patients with diabetes mellitus are at increased risk of postoperative complications .
Data from r and omised clinical trials and meta-analyses point to a potential benefit of intensive glycaemic control , targeting near-normal blood glucose , in patients with hyperglycaemia ( with and without diabetes mellitus ) being su bmi tted to surgical procedures .
However , there is limited evidence concerning this question in patients with diabetes mellitus undergoing surgery .
OBJECTIVES To assess the effects of perioperative glycaemic control for diabetic patients undergoing surgery .