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 .
Strict glycaemic control in patients hospitalised in a mixed medical and surgical intensive care unit: a randomised clinical trial
Introduction Critically ill patients can develop hyperglycaemia even if they do not have diabetes . Intensive insulin therapy decreases morbidity and mortality rates in patients in a surgical intensive care unit ( ICU ) and decreases morbidity in patients in a medical ICU . The effect of this therapy on patients in a mixed medical/surgical ICU is unknown . Our goal was to assess whether the effect of intensive insulin therapy , compared with st and ard therapy , decreases morbidity and mortality in patients hospitalised in a mixed ICU . Methods This is a prospect i ve , r and omised , non-blinded , single-centre clinical trial in a medical/surgical ICU . Patients were r and omly assigned to receive either intensive insulin therapy to maintain glucose levels between 80 and 110 mg/dl ( 4.4 to 6.1 mmol/l ) or st and ard insulin therapy to maintain glucose levels between 180 and 200 mg/dl ( 10 and 11.1 mmol/l ) . The primary end point was mortality at 28 days . Results Over a period of 30 months , 504 patients were enrolled . The 28-day mortality rate was 32.4 % ( 81 of 250 ) in the st and ard insulin therapy group and 36.6 % ( 93 of 254 ) in the intensive insulin therapy group ( Relative Risk [ RR ] : 1.1 ; 95 % confidence interval [ CI ] : 0.85 to 1.42 ) . The ICU mortality in the st and ard insulin therapy group was 31.2 % ( 78 of 250 ) and 33.1 % ( 84 of 254 ) in the intensive insulin therapy group ( RR : 1.06 ; 95%CI : 0.82 to 1.36 ) . There was no statistically significant reduction in the rate of ICU-acquired infections : 33.2 % in the st and ard insulin therapy group compared with 27.17 % in the intensive insulin therapy group ( RR : 0.82 ; 95%CI : 0.63 to 1.07 ) . The rate of hypoglycaemia ( ≤ 40 mg/dl ) was 1.7 % in the st and ard insulin therapy group and 8.5 % in the intensive insulin therapy group ( RR : 5.04 ; 95 % CI : 1.20 to 21.12 ) . Conclusions IIT used to maintain glucose levels within normal limits did not reduce morbidity or mortality of patients admitted to a mixed medical/surgical ICU . Furthermore , this therapy increased the risk of hypoglycaemia . Trial Registration clinical trials.gov Identifiers : 4374 - 04 - 13031 ; 094 - 2 in
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 .