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 .
Early postoperative glucose control predicts nosocomial infection rate in diabetic patients.
OBJECTIVES To determined the relationship between perioperative glucose control and postoperative nosocomial infection rate is 100 consecutive diabetic patients undergoing elective surgery . DESIGN AND PATIENTS One hundred initially uninfected diabetic patients undergoing elective surgery were prospect ively monitored for perioperative glucose control and postoperative nosocomial infection rate . Glucose control was determined by the attending surgeon or diabetologist . SETTING A large tertiary care hospital that serves as the in-patient facility for a local diabetes center . MAIN OUTCOME MEASURES All patients were screened for infection preoperatively . Only initially uninfected patients were enrolled , and all patients received perioperative antibiotic coverage . Perioperative glucose control and postoperative nosocomial infection rate were monitored prospect ively . APACHE II scores were determined on all patients . Patients were stratified into two groups : those with relatively " good " perioperative glucose control ( all values < or = 220 mg/dL ) and those with " poor " control ( at least one value > 220 mg/dL ) . Contingency tables were generated , comparing nosocomial infection rates vs perioperative glucose control . Correlation coefficients between APACHE II score and maximum and mean glucose values were also determined . RESULTS A serum glucose > 220 mg/dL on postoperative day one ( POD 1 ) was a sensitive ( 87.5 % ) but relatively nonspecific ( 33.3 % ) predictor of the later development of postoperative nosocomial infection . In patients with hyperglycemia ( > 220 mg/dL ) on POD 1 , the infection rate was 2.7 times that observed ( 31.3 % vs 11.5 % ) in diabetic patients with all serum glucose values < 220 mg/dL. When minor infection of the urinary tract was excluded , the relative risk for " serious " postoperative infection increased to 5.7 when any POD 1 blood glucose level was > 220 mg/dL. On the basis of correlation coefficients between serum glucose values and APACHE II score , only 18 % of the variance in the highest serum glucose could be explained by disease severity alone . CONCLUSIONS We conclude that diabetic patients undergoing major cardiovascular or abdominal surgery have an increased risk of infection that is further exacerbated by early postoperative hyperglycemia . The high rate of nosocomial infection observed in diabetic patients with poor glucose control suggests that hyperglycemia itself may be an independent risk factor for the development of infection . Efforts to improve perioperative glucose homeostasis in diabetic patients may reduce the incidence of nosocomial infection and thereby improve outcome
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 .