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 .
Comparison of once-daily glargine insulin with twice-daily NPH/regular insulin for control of hyperglycemia in inpatients after cardiovascular surgery.
BACKGROUND Traditionally hyperglycemia in surgical in patients has been managed with six-hourly sliding-scale regular insulin . However , this approach is usually ineffective in preventing hyperglycemia since no basal insulin is provided . We compared glycemic control using NPH and regular insulin versus glargine insulin alone in patients after cardiovascular surgery on a general surgical ward . METHODS Ninety-four hyperglycemic patients were r and omized to subcutaneous insulin using twice-daily NPH/regular or once-daily glargine if they required at least 1 unit/h of intravenous insulin at the time of transfer from the ICU . NPH/regular was adjusted twice daily ; glargine was adjusted once daily . Blood glucose was measured four times daily and targeted to 80 - 140 mg/dL. RESULTS The mean blood glucose after NPH/regular ( 124 mg/dL ) and glargine ( 131 mg/dL ) was similar ( P = 0.065 ) . In the subgroup of patients with a history of diabetes , mean blood glucose was significantly lower after NPH/regular ( 133 mg/dL ) versus glargine ( 154 mg/dL ) ( P = 0.016 ) . Blood glucose less than 60 mg/dL was significantly less common after glargine ( 0.5 % ) as compared with NPH/regular ( 2 % ) ( P = 0.036 ) . CONCLUSIONS Once-daily glargine insulin provides good glycemic control in hyperglycemic patients after cardiovascular surgery . Although twice-daily NPH/regular insulin provided better control than glargine insulin monotherapy , the simplicity and safety of glargine insulin make it an attractive option for the management of postoperative hyperglycemia . Patients with established diabetes will achieve better glucose control with NPH/regular insulin as compared with glargine but have a higher incidence of hypoglycemia
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 .