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 .
Use of i.v. insulin in well-controlled non-insulin-dependent diabetics undergoing major surgery.
We conducted a r and omized , prospect i ve study to assess the effect of i.v . insulin on blood glucose control , development of ketone bodies and hormonal changes in 60 well-controlled , non-insulin-dependent diabetics ( NIDDM ) undergoing major surgery . In group A , patients were given only 0.9 % saline ; in group B , patients were given insulin as a continuous i.v . infusion ( 1.25 u. h-1 ) ; in group C , patients were given insulin 10 u. i.v . boluses every 2 h. Patients in all three groups were given insulin 5 u. when their intraoperative blood glucose concentration increased to greater than 11.1 mmol litre-1 . Blood glucose concentrations were measured every 15 min , from just before induction of anaesthesia to 2 h after surgery . Plasma lactate , pyruvate , ketone body , C-peptide and counter-regulatory hormone concentrations were also measured . Blood glucose concentrations in the three groups did not differ significantly . There was a mild-to-moderate increase in plasma ketone body concentrations in group A , but without any deleterious consequences . Plasma C-peptide concentrations decreased significantly in groups B and C , especially in patients given bolus injections of insulin . Plasma growth hormone concentrations also increased significantly in group B and C patients . This study indicated that the " no insulin -- no glucose " regimen was a simple , effective way to control blood glucose in well-controlled NIDDM patients , provided blood glucose was measured frequently and insulin used appropriately
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 .