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 .
Perioperative hyperinsulinaemic normoglycaemic clamp causes hypolipidaemia after coronary artery surgery.
BACKGROUND Glucose-insulin-potassium ( GIK ) administration is advocated on the premise of preventing hyperglycaemia and hyperlipidaemia during reperfusion after cardiac interventions . Current research has focused on hyperglycaemia , largely ignoring lipids , or other substrates . The present study examines lipids and other substrates during and after on-pump coronary artery bypass grafting and how they are affected by a hyperinsulinaemic normoglycaemic clamp . METHODS Forty-four patients were r and omized to a control group ( n=21 ) or to a GIK group ( n=23 ) receiving a hyperinsulinaemic normoglycaemic clamp during 26 h.  Plasma levels of free fatty acid ( FFA ) , total and lipoprotein ( VLDL , HDL , and LDL)-triglycerides ( TG ) , ketone bodies , and lactate were determined . RESULTS In the control group , mean FFA peaked at 0.76 ( sem 0.05 ) mmol litre(-1 ) at early reperfusion and decreased to 0.3 - 0.5 mmol litre(-1 ) during the remaining part of the study . GIK decreased FFA levels to 0.38 ( 0.05 ) mmol litre(-1 ) at early reperfusion , and to low concentrations of 0.10 ( 0.01 ) mmol litre(-1 ) during the hyperinsulinaemic clamp . GIK reduced the area under the curve ( AUC ) for FFA by 75 % and for TG by 53 % . The reduction in total TG was reflected by a reduction in the VLDL ( -54 % AUC ) and HDL ( -42 % AUC ) fraction , but not in the LDL fraction . GIK prevented the increase in ketone bodies after reperfusion ( -44 to -47 % AUC ) , but was without effect on lactate levels . CONCLUSIONS Mild hyperlipidaemia was only observed during early reperfusion ( before heparin reversal ) and the hyperinsulinaemic normoglycaemic clamp actually result ed in hypolipidaemia during the largest part of reperfusion after cardiac 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 .