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 .
Effect of intensive insulin therapy on insulin sensitivity in the critically ill.
CONTEXT Hyperglycemia and hyperinsulinemia are common in intensive care unit ( ICU ) patients and relate to illness severity . Intensive insulin therapy ( IIT ) to maintain normoglycemia reduces morbidity and mortality . Blood glucose control explains this benefit because a high insulin dose is associated with adverse outcome . Mitogenic insulin effects could theoretically explain this link . OBJECTIVE To investigate further the association between insulin dose and adverse outcome , we studied the effect of IIT on circulating insulin levels , markers of insulin sensitivity , and the metabolic and mitogenic insulin signaling molecules in key tissues . DESIGN This is a sub analysis of a large r and omized , controlled study . SETTING The study was performed in a university hospital surgical ICU . PATIENTS A total of 339 critically ill patients , treated in ICU for at least a week , were included in this sub analysis . INTERVENTION Strict normoglycemia with IIT compared with conventional insulin therapy was performed . RESULTS Severalfold higher insulin doses than with conventional insulin therapy were required to maintain normoglycemia with IIT . However , serum insulin levels were only transiently higher with IIT , despite the much lower blood glucose levels . IIT normalized the elevated serum C-peptide levels and increased circulating adiponectin levels . The metabolic insulin signal was increased by IIT in muscle , but not in liver . The mitogenic insulin signal in either tissue was not affected by IIT . CONCLUSIONS Normoglycemia can be maintained in ICU patients without a sustained further elevation of insulinemia . Together with the increased adiponectin levels , this finding suggests that IIT may improve insulin sensitivity . Skeletal muscle , but not liver , revealed an increased metabolic insulin signal . The therapy did not impose mitogenic risk in these tissues
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 .