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 .
Perioperative Glucose and Insulin Administration While Maintaining Normoglycemia (GIN Therapy) in Patients Undergoing Major Liver Resection
BACKGROUND : Although hyperglycemia is a well-recognized risk factor in the context of cardiac surgery , the relevance of perioperative glycemic control for patients undergoing major noncardiac operations has received little attention . We design ed this study to assess the hyperglycemic response to liver resection , and to test the hypothesis that perioperative glucose and insulin administration while maintaining normoglycemia ( GIN therapy ) provides glycemic control superior to that achieved by the conventional use of insulin . METHODS : Patients were r and omly assigned to GIN therapy or st and ard therapy ( control group ) . In the GIN therapy group , insulin was administered at 2 mU · kg−1 · min−1 during surgery . At the end of surgery , the insulin infusion was decreased to 1 mU · kg−1 · min−1 and continued for 24 hours . Dextrose 20 % was infused at a rate adjusted to maintain blood glucose within the target range of 3.5 to 6.1 mmol · L−1 ( 63–110 mg · dL−1 ) . Patients in the st and ard therapy group received a conventional insulin sliding scale during and after surgery . The mean and SD of blood glucose as well as the percentage of blood glucose values within the target range were calculated . To evaluate intrasubject variability , the coefficient of variability ( CV ) of blood glucose was calculated for each patient . Episodes of severe hypoglycemia , i.e. , blood glucose < 2.2 mmol · L−1 ( 40 mg · dL−1 ) , were recorded . The primary outcome was the proportion of normoglycemic measurements . RESULTS : We studied 52 patients .  The mean blood glucose value in patients receiving GIN therapy always remained within the target range . The blood glucose levels were lower in the GIN therapy group than in the st and ard therapy group ( during surgery , P < 0.01 ; after surgery , P < 0.001 ) . In nondiabetic patients receiving GIN therapy ( n = 19 ) , target glycemia was achieved in 90.1 % of the blood glucose measurements during surgery and in 77.8 % of the measurements after surgery . In diabetic patients receiving GIN therapy ( n = 7 ) , target glycemia was achieved in 81.2 % of the blood glucose measurements during surgery and in 70.5 % of the measurements after surgery . In nondiabetic patients receiving st and ard therapy ( n = 19 ) , target glycemia was achieved in 37.4 % of the blood glucose measurements during surgery and in 18.3 % of the measurements after surgery . In diabetic patients receiving st and ard therapy ( n = 7 ) , target glycemia was achieved in 4.3 % of the blood glucose measurements during surgery and in 2.9 % of the measurements after surgery . The SD and CV of blood glucose were smaller in the GIN therapy group than in the st and ard therapy group , especially in nondiabetic patients after surgery ( SD , P < 0.001 ; CV , P = 0.027 ) . No patients receiving GIN therapy experienced severe hypoglycemia during surgery . One patient receiving GIN therapy experienced hypoglycemia in the intensive care unit after surgery without neurological sequelae . CONCLUSIONS : GIN therapy effectively provides normoglycemia in patients undergoing liver resection ( clinical trials.gov , NCT00774098 )
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 .