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 .
Intensive Insulin Therapy in Mixed Medical/Surgical Intensive Care Units
Intensive insulin therapy ( IIT ) improves the outcome of prolonged critically ill patients , but concerns remain regarding potential harm and the optimal blood glucose level . These questions were addressed using the pooled data set of two r and omized controlled trials . Independent of parenteral glucose load , IIT reduced mortality from 23.6 to 20.4 % in the intention-to-treat group ( n = 2,748 ; P = 0.04 ) and from 37.9 to 30.1 % among long stayers ( n = 1,389 ; P = 0.002 ) , with no difference among short stayers ( 8.9 vs. 10.4 % ; n = 1,359 ; P = 0.4 ) . Compared with blood glucose of 110–150 mg/dl , mortality was higher with blood glucose > 150 mg/dl ( odds ratio 1.38 [ 95 % CI 1.10–1.75 ] ; P = 0.007 ) and lower with < 110 mg/dl ( 0.77 [ 0.61–0.96 ] ; P = 0.02 ) . Only patients with diabetes ( n = 407 ) showed no survival benefit of IIT . Prevention of kidney injury and critical illness polyneuropathy required blood glucose strictly < 110 mg/day , but this level carried the highest risk of hypoglycemia . Within 24 h of hypoglycemia , three patients in the conventional and one in the IIT group died ( P = 0.0004 ) without difference in hospital mortality . No new neurological problems occurred in survivors who experienced hypoglycemia in intensive care units ( ICUs ) . We conclude that IIT reduces mortality of all medical/surgical ICU patients , except those with a prior history of diabetes , and does not cause harm . A blood glucose target < 110 mg/day was most effective but also carried the highest risk 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 .