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 Three Protocols for Tight Glycemic Control in Cardiac Surgery Patients
OBJECTIVE We performed a r and omized trial to compare three insulin-titration protocol s for tight glycemic control ( TGC ) in a surgical intensive care unit : an absolute glucose ( Matias ) protocol , a relative glucose change ( Bath ) protocol , and an enhanced model predictive control ( eMPC ) algorithm . RESEARCH DESIGN AND METHODS A total of 120 consecutive patients after cardiac surgery were r and omly assigned to the three protocol s with a target glycemia range from 4.4 to 6.1 mmol/l . Intravenous insulin was administered continuously or in combination with insulin boluses ( Matias protocol ) . Blood glucose was measured in 1- to 4-h intervals as requested by the protocol s. RESULTS The eMPC algorithm gave the best performance as assessed by time to target ( 8.8 ± 2.2 vs. 10.9 ± 1.0 vs. 12.3 ± 1.9 h ; eMPC vs. Matias vs. Bath , respectively ; P < 0.05 ) , average blood glucose after reaching the target ( 5.2 ± 0.1 vs. 6.2 ± 0.1 vs. 5.8 ± 0.1 mmol/l ; P < 0.01 ) , time in target ( 62.8 ± 4.4 vs. 48.4 ± 3.28 vs. 55.5 ± 3.2 % ; P < 0.05 ) , time in hyperglycemia > 8.3 mmol/l ( 1.3 ± 1.2 vs. 12.8 ± 2.2 vs. 6.5 ± 2.0 % ; P < 0.05 ) , and sampling interval ( 2.3 ± 0.1 vs. 2.1 ± 0.1 vs. 1.8 ± 0.1 h ; P < 0.05 ) . However , time in hypoglycemia risk range ( 2.9–4.3 mmol/l ) in the eMPC group was the longest ( 22.2 ± 1.9 vs. 10.9 ± 1.5 vs. 13.1 ± 1.6 ; P < 0.05 ) . No severe hypoglycemic episode ( < 2.3 mmol/l ) occurred in the eMPC group compared with one in the Matias group and two in the Bath group . CONCLUSIONS The eMPC algorithm provided the best TGC without increasing the risk of severe hypoglycemia while requiring the fewest glucose measurements . Overall , all protocol s were safe and effective in the maintenance of TGC in cardiac surgery patients
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 .