Perioperative glycaemic control for people with diabetes undergoing surgery

. 2023 Aug 1;2023(8):CD007315. doi: 10.1002/14651858.CD007315.pub3

Study ID	Intervention(s) and comparator(s)	Sex (female %)	Age (mean years (SD))	HbA1c (mean % (SD)	BMI (mean kg/m² (SD))	Co‐medications/Co‐interventions (% of participants)	Co‐morbidities (% of participants)
Duncan 2018	I: hyperinsulinaemic normoglycaemia	27^a	66 (11)^a	—	28.5 (5.7)^a	ACE inhibitor: (39)^a Antiarrhythmic: (8)^a ß‐blocker: (63)^a Calcium blocker: (19)^a Cox‐2 inhibitor: (2)^a Statin: (69)^a Steroid: (5)^a Diabetic medication: (30)^a Sulfonylureas or meglitinides: (8) Biguanides (metformin): (20) Thiazolidinediones: (3) Insulin: (11)	Diabetes: (32)^a COPD/asthma: (16)^a Pulmonary hypertension: (15)^a Stroke: (6)^a Hypertension: (67)^a Heart failure: (21)^a Myocardial infarction: (28)^a Dialysis: (1)^a Peripheral vascular disease: (7)^a Smoking: (29)^a ASA physical status:^a II: (0) III: (49) IV: (5) V: (0)
Duncan 2018	C: standard therapy	26^a	66 (11)^a	—	28.3 (5.4)^a	ACE inhibitor: 37^a Antiarrhythmic: (10)^a ß‐Blocker: (64)^a Calcium blocker: (21)^a Cox‐2 inhibitor: (0)^a Statin: (69)^a Steroid: (3)^a Diabetic medication (29):^a Sulfonylureas or meglitinides (9) Biguanides (metformin) (19) Thiazolidinediones (2) Insulin (10)	Diabetes: (34)^a COPD/asthma: (12)^a Pulmonary hypertension:(14)^a Stroke: (15)^a Hypertension: (79)^a Heart failure: (19)^a Myocardial infarction: (24)^a Dialysis: (1)^a Peripheral vascular disease: (6)^a Smoking: (25)^a ASA physical status:^a II: (0) III: (49) IV: (51) V: (0)
Wallia 2017	I: intensive (140)	23*	57.8 (6.06)*	—	32.0 (6.5)*	—	—
Wallia 2017	C: moderate (180)	26*	60.4 (5.5)*	—	30.5 (6.85)*	—	—
Wahby 2016	I: tight glycaemic control	18 (26.87)	54.99 (6.49)	—	—	—	Hypertension: (80.6) Renal dysfunction: (7.5) Cerebrovascular accident: (4.5) Myocardial infarction: (35.8)
Wahby 2016	C: conventional moderate glycaemic control	22 (32.35)	56.40 (7.79)	—	—	—	Hypertension: (77.9) Renal dysfunction: (4.4) Cerebrovascular accident: (2.9) Myocardial infarction: (32.3)
Parekh 2016	I: moderately intense control	10 (33)	60.9 (9.1)	6.5 (1.2)	27.33 (4.19)	Insulin: (56.7) Oral agents: (20) None: (23.3)	—
Parekh 2016	C: standard glucose control	10 (33)	60.7 (11)	6.7 (1)	29.23 (6.24)	Insulin: (56.7) Oral agents: (23.3) None: 20	—
Yuan 2015	I: intensive glycaemic (IG) management	60 (56.6)	60.5 (13.2)	8.0 (0.6)	22.1 (2.5)	Insulin: 71 (67) Oral agents: 25 (23.6) None: 10 (9.4)	Respiratory disfunction: (5.7) Cardiovascular disfunction: (15.1) Liver disfunction: (2.8) Renal disfunction: (0.9) Cerebrovascular disease: (1.9)
Yuan 2015	C: conventional glycaemic (CG) management	65 (61.3)	61.1 (13.5)	7.9 (0.5)	21.6 (2.0)	Insulin: 67 (63.2) Oral agents: 30 (28.3) None: 9 (8.5)	Respiratory disfunction: (7.5) Cardiovascular disfunction: (14.2) Liver disfunction: (3.8) Renal disfunction: (1.9) Cerebrovascular disease: (1.9)
Umpierrez 2015	I: intensive group	29 (38)*	65.2 (9.1)*	8.2 (2.0)*	32.9 (8.0)*	No antidiabetic agents: (9)^a Oral agents: (45)^a Insulin alone: (20)^a Insulin + oral agents: (26)^a	Previous smoking: (42)^a Current smoking: (23)^a Dyslipidaemia: (86)^a Hypertension: (94)^a
Umpierrez 2015	C: conservative control	20 (27)*	62.8 (9.1)*	7.8 (2.0)*	32.1 (7.3)*	No antidiabetic agents: (7)^a Oral agents: (48)^a Insulin alone: (20)^a Insulin + oral agents: (25)^a	Previous smoking: (51)^a Current smoking: (33)^a Dyslipidaemia: (81)^a Hypertension: (91)^a
Abdelmalak 2013	I: intensive glucose management	39*	68.1 (10.6)*	8 (2.21)*	29.2 (6.62)*	—	Any type of co‐morbidities: 94.4*
Abdelmalak 2013	C: conventional glucose management	25*	66.9 (9.85)*	7.7 (1.48)*	29.5 (6.66)*	—	Any type of co‐morbidities: 89.9*
Hermayer 2012	I: experimental group	32	58 (9.8)	7 (1.8)	—	—	Hyperlipidaemia: 45 Hypertension: 95 Cardiovascular disease: 39 Previous myocardial infarction:11 Congestive heart failure: 9 Atrial fibrillation: 9 Cerebrovascular events: 11 Vascular disease: 25
Hermayer 2012	C: control group	29	56.3 (9.6)	7.2 (1.7)	—	—	Hyperlipidaemia: 49 Hypertension: 100 Cardiovascular disease: 33 Previous myocardial infarction: 10 Congestive heart failure: 14 Atrial fibrillation: 12 Cerebrovascular events: 12 Vascular disease: 31
Desai 2012	I: liberal blood glucose control	25*	62.7 (9.4)*	7.4 (1.3)*	33.5 (8.5)*	Aspirin: 94^a Beta‐blockers: 93^a ACE/ARB inhibitors: 47^a Lipid‐lowering medications: 94^a	Hypertension: 86^a Congestive heart failure: 9^a
Desai 2012	C: strict blood glucose control	14*	62.6 (10.6)*	7.9 (1.5)*	31.2 (7.4)*	Aspirin: 92^a Beta‐blockers: 85^a ACE/ARB inhibitors: 51^a Lipid‐lowering medications: 92^a	Hypertension: 8^a Congestive heart failure: 13^a
Lazar 2011	I: aggressive glucose control	20	63 (9)	8.4 (1.5)	—	(1) Insulin: 38 (2) Oral diabetic medication: 52 (3) Insulin and oral diabetic medication: 5 (4) hyperlipidaemia medication: 100 (5) B‐blockers: 100 (6) Statins: 100 (7) ACE inhibitors: 60	(1) Angina class IV: 33 (2) Congestive heart failure: 13 (3) Myocardial infarction: 57 (4)Hypertension: 93 (5) Left main disease: 15
Lazar 2011	C: moderate glucose control	38	65 (9)	8.3 (1.5)	—	(1) Insulin: 31 (2) Oral diabetic medication: 48 (3) Insulin and oral diabetic medication: 11 (4) hyperlipidaemia medication: 100 (5) B‐blockers: 100 (6) Statins: 100 (7) ACE inhibitors: 59	(1) Angina class IV: 33 (2) Congestive heart failure: 14 (3) Myocardial infarction: 57 (4) Hypertension: 100 (5) Left main disease: 21
Cao 2010	I: intensive insulin therapy	70	58.2 (6.3)	7.5 (0.7)	21.1 (2.0)	(1) Insulin treatment: 65.2 (2) Oral agents: 27.2	Hypertension: 18.5 Coronary artery disease: 2.2 Cardiac insufficiency: 7.6 Pulmonary disease: 4.3 Renal insufficiency: 1 Liver insufficiency: 4.3 Any preoperative co‐morbidity: 38.0
Cao 2010	C: conventional insulin therapy	66	59.4 (7.3)	7.3 (0.6)	22.2 (2.6)	(1) Insulin treatment: 72.4 (2) Oral agents: 21.8	Hypertension: 17.2 Coronary artery disease: 1.1 Cardiac insufficiency: 5.7 Pulmonary disease: 5.7 Renal insufficiency: 2.3 Liver insufficiency: 3.4 Any preoperative co‐morbidity: 35.6
Glucontrol 2009	I: intensive insulin treatment	31*	66 (14)*	—	29.8 (5)*	Vasopressors/inotropes: 37.5^a	—
Glucontrol 2009	C: intermediate glucose control	42*	67 (10)*	—	28.9 (4.7)*	Vasopressors/inotropes: 40.2^a	—
NICE SUGAR 2009	I: intensive insulin therapy	41*	65.4 (12.2)*	—	30.8 (7.4)*	Corticosteroid treatment: 34.6^a	(1) Respiratory dysfunction: 40.3^a (2) Respiratory failure: 51^a (3) Coagulatory dysfunction: 31.7^a (4) Coagulatory failure: 4.3^a (5) Hepatic dysfunction: 29.6^a (6) Hepatic failure: 2.5^a (7) Cardiovascular dysfunction: 19.4^a (8) Cardiovascular failure: 57.3^a (9) Renal dysfunction: 35^a (10) Renal failure: 8.4^a (11) Diabetes: 20.4^a
NICE SUGAR 2009	C: conventional insulin therapy	31*	65.4 (12.4)*	—	30.9 (8.3)*	Corticosteroid treatment: 31.7^a	(1) Respiratory dysfunction: 40.9^a (2) Respiratory failure: 50.9^a (3) Coagulatory dysfunction: 29.2^a (4) Coagulatory failure: 4.6^a (5) Hepatic dysfunction: 29.8^a (6) Hepatic failure: 1.8^a (7) Cardiovascular dysfunction: 20.4^a (8) Cardiovascular failure: 56.3^a (9) Renal dysfunction: 36^a (10) Renal failure: 7.7^a (11) Diabetes: 19.8^a
Subramaniam 2009	I: intensive insulin therapy	41^a	67 (10)^a	—	30 (8)^a	(1) Statin: 67^a (2) Aspirin: 85^a (3) ACE inhibitor: 56^a (4) B‐blocker: 73^a (5) Insulin: 65^a (6) Metformin: 15^a (7) Glyburide: 37^a	(1) Diabetes: 54^a (2) Hypertension: 81^a (3) CAD: 51^a (4) CHF: 11^a (5) CABG: 21^a (6) CRF: 13^a (7) Stroke: 8^a (8) COPD: 20^a
Subramaniam 2009	C: conventional insulin therapy	46^a	71 (11)^a	—	28 (8)^a	(1) Statin: 57^a (2) Aspirin: 84^a (3) ACE inhibitor: 57^a (4) B‐blocker: 80^a (5) Insulin: 53^a (6) Metformin: 19^a (7) Glyburide: 30^a	(1) Diabetes: 53^a (2) Hypertension: 78^a (3) CAD: 58^a (4) CHF: 9^a (5) CABG: 30^a (6) CRF: 12^a (7) Stroke: 9^a (8) COPD: 25^a
Chan 2009	I: intensive insulin therapy	57^a	57 (12)^a	—	24 (3.4)^a	—	—
Chan 2009	C: conventional insulin therapy	43^a	58 (12)^a	—	26 (4.9)^a	—	—
De La Rosa 2008	I: intensive insulin therapy	42^a	59.4 (14.6)*	—	26.6 (5.0)*	—	(1) History of diabetes: 32^a (2) History of cirrhosis: 9^a (3) History of heart failure: 6^a (4) History of kidney failure: 10^a (5) History of cancer: 15^a
De La Rosa 2008	C: conventional insulin therapy	38^a	73.5 (12.0)*	—	21.9 (4.3)*	—	(1) History of diabetes: 29^a (2) History of cirrhosis: 7^a (3) History of heart failure: 3^a (4) History of kidney failure: 16^a (5) History of cancer: 9^a
Gandhi 2007	I: intensive insulin therapy	28^a	63 (15)^a	7 (2)^a	30 (6)^a	Insulin: 22^a Oral diabetic medication: 54^a Insulin and oral diabetic medication: 16^a Angiotensin‐converting enzyme inhibitor: 35^a B‐blocker: 52^a Antiarrhythmic: 9^a Aspirin: 48^a	Diabetes: 20^a Chronic renal failure: 1^a History of myocardial infarction: 11^a Stroke or transient ischaemic attack: 11^a ASA II: 2^a ASA III: 88^a ASA IV: 10^a
Gandhi 2007	C: conventional insulin therapy	34^a	63 (16)^a	7 (2)^a	29 (6)^a	Insulin: 28^a Oral diabetic medication: 31^a Insulin and oral diabetic medication: 19^a Angiotensin‐converting enzyme inhibitor: 39^a B‐blocker: 55^a Antiarrhythmic: 10^a Aspirin: 60^a	Diabetes: 19^a Chronic renal failure: 2^a History of myocardial infarction: 16^a Stroke or transient ischaemic attack: 7^a ASA II: 1^a ASA III: 88^a ASA IV: 11^a
Li 2006	I: continuous insulin Infusion	39	63.5	—	25.1	Insulin: (5.9) Oral hypoglycaemic agents: (86.3) Diuretics: (17.6) Inotropic agents: (7.8)	Smoking: (45.1) Hypertension: (84.3) Congestive heart failure: (56.9) Renal insufficiency: (9.8) Stroke: (7.8) Peripheral vascular disease: (3.9) Chronic obstructive pulmonary disease: (5.9) Previous myocardial infarction: (51) Left main stenosis: (25.5)
Li 2006	C: glucometer‐guided insulin	36	63.7	—	25.4	Insulin: (11.9) Oral hypoglycaemic agents: (78.6) Diuretics: (28.6) Inotropic agents: (4.8)	Smoking: (40.5) Hypertension: (81.1) Congestive heart failure: (59.5) Renal insufficiency: (14.3) Stroke: (16.7) Peripheral vascular disease: (2.4) COPD: (9.5) Previous myocardial infarction: (61.9) Left main stenosis: (31)
Lazar 2004	I: tight glycaemic control with GIK	42	63.7 (1.4)	—	—	IV: nitroglycerin (31.9) IV: heparin (58.3) Insulin: (31.9) Oral diabetic medication: (59.7)	Congestive heart failure: (27.7) Myocardial infarction: (70.8) Hypertension: (77.7) COPD: (8.3) Left main disease: (19.4)
Lazar 2004	C: standard therapy	33	63 (1.5)	—	—	IV: nitroglycerin (33.3) IV: heparin (62.3) Insulin: (27.5) Oral diabetic medication: (59.4)	Congestive heart failure: (39.1) Myocardial infarction: (71.0) Hypertension: (68.1) Chronic obstructive pulmonary disease:(4.3) Left main disease: (24.6)
Rassias 1999	I: aggressive insulin therapy	23	64.3 (9.3)	—	27.8 (3.4)	—	—
Rassias 1999	C: standard insulin therapy	62	68.4 (7.5)	—	28.7 (3.1)	—	—
—: denotes not reported denotes data provided by trial authors. ^aData from total trial population. BMI: body mass index; GIK: glucose‐insulin‐potassium; HbA1c: glycosylated haemoglobin A1c; SD: standard deviation; CAD: coronary artery disease; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; CRF: chronic renal failure; CABG: coronary artery bypass grafting; ASA*: American Society Anaesthesiologists; IV: intravenous.