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 .
Cardioprotective effects of glucose and insulin administration while maintaining normoglycemia (GIN therapy) in patients undergoing coronary artery bypass grafting.
CONTEXT Coronary artery bypass grafting ( CABG ) is complicated by ischemia-reperfusion injury jeopardizing myocyte survival . OBJECTIVE The aim of the study was to investigate whether glucose and insulin administration , while maintaining normoglycemia ( GIN therapy ) using a hyperinsulinemic-normoglycemic clamp technique , is cardioprotective in patients undergoing CABG . DESIGN AND SETTING We conducted a r and omized controlled trial at a tertiary care university teaching hospital . PATIENTS We studied 99 patients undergoing elective CABG . INTERVENTION Patients were r and omly assigned to receive either GIN from the beginning of surgery until 24 h after CABG ( GIN , n = 49 ) or st and ard metabolic care ( control , n = 50 ) . MAIN OUTCOME MEASURES We measured plasma concentrations of cardiac troponin I and free fatty acids , cardiac function as assessed by transesophageal echocardiography , glycogen content , glycogen synthase activity , and the expression of AMP-activated protein kinase ( AMPK ) and protein kinase B ( AKT ) in cardiomyocytes . RESULTS Patients receiving GIN therapy showed an attenuated release of cardiac troponin I ( P < 0.05 ) and improved myocardial function ( P < 0.05 ) . Systemic free fatty acid concentrations were suppressed ( P < 0.05 ) , whereas intracellular glycogen content and glycogen synthase activity were not altered . The AMPK activity remained unchanged during ischemia in the GIN group , whereas it increased in the control group ( P < 0.05 ) . Enhanced AKT phosphorylation before ischemia was observed ( P < 0.05 ) in the presence of GIN . However , there was no evidence for AKT-dependent AMPK inhibition . CONCLUSIONS GIN therapy protects the myocardium and inhibits ischemia-induced AMPK activation
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 .