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 .
Control of hyperglycaemia in paediatric intensive care (CHiP): study protocol
Background There is increasing evidence that tight blood glucose ( BG ) control improves outcomes in critically ill adults . Children show similar hyperglycaemic responses to surgery or critical illness . However it is not known whether tight control will benefit children given maturational differences and different disease spectrum . Methods / Design The study is an r and omised open trial with two parallel groups to assess whether , for children undergoing intensive care in the UK aged ≤ 16 years who are ventilated , have an arterial line in-situ and are receiving vasoactive support following injury , major surgery or in association with critical illness in whom it is anticipated such treatment will be required to continue for at least 12 hours , tight control will increase the numbers of days alive and free of mechanical ventilation at 30 days , and lead to improvement in a range of complications associated with intensive care treatment and be cost effective . Children in the tight control group will receive insulin by intravenous infusion titrated to maintain BG between 4 and 7.0 mmol/l . Children in the control group will be treated according to a st and ard current approach to BG management . Children will be followed up to determine vital status and healthcare re sources usage between discharge and 12 months post-r and omisation . Information regarding overall health status , global neurological outcome , attention and behavioural status will be sought from a subgroup with traumatic brain injury (TBI).A difference of 2 days in the number of ventilator-free days within the first 30 days post-r and omisation is considered clinical ly important . Conservatively assuming a st and ard deviation of a week across both trial arms , a type I error of 1 % ( 2-sided test ) , and allowing for non-compliance , a total sample size of 1000 patients would have 90 % power to detect this difference . To detect effect differences between cardiac and non-cardiac patients , a target sample size of 1500 is required . An economic evaluation will assess whether the costs of achieving tight BG control are justified by subsequent reductions in hospitalisation costs . Discussion The relevance of tight glycaemic control in this population needs to be assessed formally before being accepted into st and ard practice .Trial Registration Current Controlled Trials IS RCT
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 .