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Although some clinicians advocate aggressive insulin therapy to achieve euglycemia perioperatively, this approach remains controversial. A multicenter investigative group performed this meta-analysis of randomized trials in which perioperative insulin infusion (to maintain tight glycemic control) was compared with less-intensive interventions in surgical patients.
The authors identified 34 trials involving 5150 patients (both diabetic and nondiabetic); 14 trials provided mortality data. Perioperative mortality was significantly lower with insulin infusions than with control interventions (relative risk, 0.69; 95% confidence interval, 0.51–0.94). Hypoglycemia occurred significantly more commonly with intensive insulin infusions. Other outcome…