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 blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life.
AIMS To document the impact of intensive insulin therapy during intensive care on long-term ( 4 years ) outcome of high-risk cardiac surgery patients . METHODS AND RESULTS In this pre-planned sub- analysis and follow-up study of a large , r and omized controlled trial on the effects of intensive insulin therapy during critical illness , we assessed long-term outcome in the 970 patients who had been admitted after high-risk cardiac surgery ( mean+/-SD EuroSCORE of 6.0+/-3.7 ; EuroSCORE-predicted hospital mortality of 9.9 % ; observed hospital mortality of 7.5 % in the conventional insulin group and 3.4 % in the intensive insulin group ) . Long-term outcome was quantified as : ( a ) 4 years survival ; ( b ) incidence of hospital re-admission ; ( c ) level of activity and medical care requirements at 4 years as assessed by the Karnofsky score ; and ( d ) perceived health-related quality -of-life at 4 years as assessed by the Nottingham Health Profile . Four years after ICU admission , the number of post-hospital discharge deaths was similar in the two study groups , reflecting maintenance of the acute survival benefit with intensive insulin therapy . Survivors who had been treated with intensive insulin during ICU stay revealed a similar risk for hospital re-admission and a comparable level of dependency on medical care . There was no effect on quality -of-life in the total group , whereas the increased survival of sicker patients with at least 3 days of insulin therapy evoked a more compromised perceived quality -of-life , in particular regarding social and family life . CONCLUSION The short-term survival benefit obtained with insulin-titrated glycaemic control during intensive care after cardiac surgery was maintained after 4 years , without inducing increased medical care requirements but possibly at the expense of compromised perceived quality of social and family life
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 .