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 .
High-dose insulin therapy attenuates systemic inflammatory response in coronary artery bypass grafting patients.
BACKGROUND Cardiac surgery with cardiopulmonary bypass ( CPB ) induces an acute phase reaction that is implicated in the pathogenesis of several postoperative complications . Studies have shown that proinflammatory cytokines are increased by acute hyperglycemia . Recent evidence suggests that insulin has antiinflammatory properties . Therefore , we hypothesized that high-dose insulin therapy would attenuate the systemic inflammatory response to cardiopulmonary bypass and surgery in coronary artery bypass patients while maintaining normoglycemia . METHODS A total of 52 patients who presented for elective coronary artery bypass were r and omized to receive intraoperative intravenous insulin infusion , titrated to maintain blood glucose concentrations less than 180 mg/dL ( group I , n = 25 ) , or receive intraoperative fixed high dose of intravenous insulin infusion ( 5 mU/kg/min ) with dextrose 20 % infused separately to maintain a blood glucose level between 70 and 110 mg/dL ( group II , n = 27 ) . Blood sample s were collected at different time points to determine tumor necrosis factor alpha ( TNFalpha ) , interleukin 6 and 8 ( IL6 and IL8 ) , and complement factor 3 and 4 ( C3 and C4 ) . RESULTS Patients in both groups had similar preoperative characteristics . Patients in the high-dose insulin group had higher blood insulin concentrations and tighter blood glucose control . There were lower levels of IL6 ( 150 pg/dL vs 245 pg/dL , p = 0.03 ) , IL-8 ( 49 pg/dL vs 74 pg/dL , p = 0.05 ) , and TNFalpha ( 2.2 pg/dL vs 3.0 pg/dL , p = 0.04 ) in group II in the early postoperative period . CONCLUSIONS High-dose insulin therapy blunts the early postoperative surge in inflammatory response to CPB as reflected by decreased levels of IL6 , IL8 , and TNFalpha
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 .