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 critically ill patients.
BACKGROUND Hyperglycemia and insulin resistance are common in critically ill patients , even if they have not previously had diabetes . Whether the normalization of blood glucose levels with insulin therapy improves the prognosis for such patients is not known . METHODS We performed a prospect i ve , r and omized , controlled study involving adults admitted to our surgical intensive care unit who were receiving mechanical ventilation . On admission , patients were r and omly assigned to receive intensive insulin therapy ( maintenance of blood glucose at a level between 80 and 110 mg per deciliter [ 4.4 and 6.1 mmol per liter ] ) or conventional treatment ( infusion of insulin only if the blood glucose level exceeded 215 mg per deciliter [ 11.9 mmol per liter ] and maintenance of glucose at a level between 180 and 200 mg per deciliter [ 10.0 and 11.1 mmol per liter ] ) . RESULTS At 12 months , with a total of 1548 patients enrolled , intensive insulin therapy reduced mortality during intensive care from 8.0 percent with conventional treatment to 4.6 percent ( P<0.04 , with adjustment for sequential analyses ) . The benefit of intensive insulin therapy was attributable to its effect on mortality among patients who remained in the intensive care unit for more than five days ( 20.2 percent with conventional treatment , as compared with 10.6 percent with intensive insulin therapy , P=0.005 ) . The greatest reduction in mortality involved deaths due to multiple-organ failure with a proven septic focus . Intensive insulin therapy also reduced overall in-hospital mortality by 34 percent , bloodstream infections by 46 percent , acute renal failure requiring dialysis or hemofiltration by 41 percent , the median number of red-cell transfusions by 50 percent , and critical-illness polyneuropathy by 44 percent , and patients receiving intensive therapy were less likely to require prolonged mechanical ventilation and intensive care . CONCLUSIONS Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit
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 .