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 glycemic control on early diabetic renal lesions. A 5-year randomized controlled clinical trial of insulin-dependent diabetic kidney transplant recipients.
OBJECTIVE To determine whether optimized glycemic control in type I diabetic recipients of renal allografts will prevent or delay diabetic renal lesions in the allograft . DESIGN Prospect i ve , controlled , and r and omized trial of glycemic control in an inception cohort of type I diabetic renal allograft recipients . The experimental group underwent maximized glycemic control , and the st and ard group was treated in the same way as other patients in the transplant clinic . Patients underwent baseline ( before transplant ) and 5-year posttransplant allograft biopsies . SETTING University of Minnesota Hospital and Clinic and the Clinical Research Center and Hennepin County Medical Center , Minneapolis . PATIENTS Type I diabetics with terminal diabetic renal failure undergoing renal transplantation . Forty-eight patients r and omized to maximized or st and ard control completed the trial . INTERVENTION Subcutaneous insulin given several times a day or continuously ( maximized group ) and once or twice each day ( st and ard group ) was used throughout the trial . A significant difference for hemoglobin A1 level was maintained ( mean + /- SD : st and ard , 0.117 + /- 0.013 ; maximized , 0.096 + /- 0.016 ; P < 0.001 ) . MAIN OUTCOME The primary end point of this trial was the difference between the groups in renal glomerular mesangial expansion as determined by electron microscopy . RESULTS There was a more than twofold increase in the volume fraction of mesangial matrix per glomerulus in the st and ard group ( mean + /- SD , 0.043 + /- 0.034 ) compared with the maximized group ( 0.019 + /- 0.038 ; P = .024 ) . The threefold increase in arteriolar hyalinosis , the greater widening of the glomerular basement membrane , and increase of volume fraction of the total mesangium in the patients who received st and ard treatment all approached significance ( P = .10 or less ) . The incidence of severe hypoglycemic episodes was greater in the maximized group ( 1.7 per patient per year ) than in the st and ard treatment group ( < 0.1 per patient per year ; P < .001 ) . CONCLUSIONS This trial indicates a causal relationship between hyperglycemia and an important lesion of diabetic nephropathy , mesangial matrix expansion , in renal allografts transplanted into diabetic recipients . In addition , the results with other lesions central to the development of diabetic nephropathy support the major conclusion
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 .