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 versus conventional insulin therapy: A randomized controlled trial in medical and surgical critically ill patients*
Objective : The role of intensive insulin therapy in medical surgical intensive care patients remains unclear . The objective of this study was to examine the effect of intensive insulin therapy on mortality in medical surgical intensive care unit patients . Design : R and omized controlled trial . Setting s : Tertiary care intensive care unit . Patients : Medical surgical intensive care unit patients with admission blood glucose of > 6.1 mmol/L or 110 mg/dL. Intervention : A total of 523 patients were r and omly assigned to receive intensive insulin therapy ( target blood glucose 4.4–6.1 mmol/L or 80–110 mg/dL ) or conventional insulin therapy ( target blood glucose 10–11.1 mmol/L or 180–200 mg/dL ) . Measurements and Main Outcomes : The primary end point was intensive care unit mortality . Secondary end points included hospital mortality , intensive care unit and hospital length of stay , mechanical ventilation duration , the need for renal replacement therapy and packed red blood cells transfusion , and the rates of intensive care unit acquired infections as well as the rate of hypoglycemia ( defined as blood glucose ≤2.2 mmol/L or 40 mg/dL ) . There was no significant difference in intensive care unit mortality between the intensive insulin therapy and conventional insulin therapy groups ( 13.5 % vs. 17.1 % , p = 0.30 ) . After adjustment for baseline characteristics , intensive insulin therapy was not associated with mortality difference ( adjusted hazard ratio 1.09 , 95 % confidence interval 0.70–1.72 ) . Hypoglycemia occurred more frequently with intensive insulin therapy ( 28.6 % vs. 3.1 % of patients ; p < 0.0001 or 6.8/100 treatment days vs. 0.4/100 treatment days ; p < 0.0001 ) . There was no difference between the intensive insulin therapy and conventional insulin therapy in any of the other secondary end points . Conclusions : Intensive insulin therapy was not associated with improved survival  among medical surgical intensive care unit patients and was associated with increased occurrence of hypoglycemia . Based on these results , we do not advocate universal application of intensive insulin therapy in intensive care unit patients . Trial Registration : Current Controlled Trials registry ( IS RCT N07413772 ) http://www.controlled-trials.com/IS RCT N07413772/07413772 ; 2005
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 .