< Back CME Module 9: Peri-Operative Cardiac Risk Reduction Next >


Diabetes Control 

Van den Berghe(38) et al completed a randomized trial of tight glycemic control in 1258 high-risk surgical patients. High risk was defined as the need to go to intensive care postoperatively. Two thirds of the patients were undergoing cardiac surgery.The target blood glucose was 4.2-6.1 with no restriction on the amount of insulin infused. Tight glycemic control resulted in a 48% reduction in mortality. In addition, there was a decrease in the incidence of postoperative renal failure by almost 50% and a significant reduction in the amount of blood transfused. It is interesting to note that the mortality rate in the non-cardiac patients was twice that of the cardiac patients.

Presently, there is no reason not to practice tight glycemic control in all surgical patients. In fact, we believe that it should be the standard of practice.

< Back Next >