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 .
Safety and Efficacy of Intensive Insulin Therapy in Critical Neurosurgical Patients
Background : Intensive insulin therapy to maintain blood glucose at or below 6.11 mm reduces morbidity and mortality after cardiac surgery and morbidity in medical intensive care unit ( ICU ) patients . The authors investigated the clinical safety and outcome effects of intensive insulin therapy compared to conventional insulin therapy in patients receiving postoperative intensive care after neurosurgical procedures . Methods : In this prospect i ve r and omized controlled trial , 483 patients undergoing elective or emergency brain surgery were prospect ively and r and omly assigned either to intensive insulin therapy ( 241 patients ) , receiving insulin titrated to maintain blood glucose levels within the range of 4.44–6.11 mm , or to conventional insulin therapy ( 242 patients ) , receiving insulin to maintain blood glucose levels below 11.94 mm . Primary endpoint was incidence of hypoglycemia ( defined as blood glucose < 2.78 mm ) . Efficacy measures included the length of ICU stay , infection rate , and 6 months follow-up Glasgow outcome scale score and overall survival . Results : Hypoglycemia episodes were more frequent in patients receiving intensive insulin therapy , median ( min – max ) : 8 ( 0–23 ) versus 3 ( 0–4 ) ; P < 0.0001 . The length of stay in the ICU was shorter ( 6 vs. 8 days ; P = 0.0001 ) , and the infection rate was lower ( 25.7 % vs. 39.3 % ; P = 0.0018 ) . Glasgow outcome scale score and overall survival at 6 months were similar in the two groups . Conclusions :  Intensive insulin therapy  in patients admitted to a postoperative neurosurgical ICU after brain surgery is associated with iatrogenic hypoglycemia , but it can also reduce the infection rate and shorten the ICU stay
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 .