***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: People with diabetes are more likely to be hospitalized and to have longer duration s of hospital stay than those without diabetes . A recent survey estimated that 22 % of all hospital inpatient days were incurred by people with diabetes and that hospital inpatient care accounted for half of the 174 billion USD total U.S. medical expenditures for this disease ( 1 ) . These findings are due , in part , to the continued expansion of the worldwide epidemic of type 2 diabetes . In the U.S. alone , there are ∼1.6 million new cases of diabetes each year , with an over all prevalence of 23.6 million people ( 7.8 % of the population , with one-fourth of the cases remaining undiagnosed ) . An additional 57 million American adults are at high risk for type 2 diabetes ( 2 ) . Although the costs of illness-related stress hyperglycemia are not known , they are likely to be considerable in light of the poor prognosis of such patients ( 3–6 ) . There is substantial observational evidence linking hyperglycemia in hospitalized patients ( with or without diabetes ) to poor outcomes . Cohort studies as well as a few early r and omized controlled trials ( RCTs ) have suggested that intensive treatment of hyperglycemia improved hospital outcomes ( 5–8 ) . In 2004 , this evidence led the American College of Endocrinology ( ACE ) and the American Association of Clinical Endocrinologists ( AACE ) , in collaboration with the American Diabetes Association ( ADA ) and other medical organizations , to develop recommendations for treatment of inpatient hyperglycemia  ( 9 ) . In 2005 , the ADA added recommendations for treatment  of hyperglycemia in the hospitalto itsannual St and ards of Medical Care ( 10 ) . Recommendations from the ACE and the ADA generally endorsed tight glycemic control in critical care units . For patients in general medical and surgical units , where RCT evidence regarding treatment targets was lacking , glycemic goals similar to those advised for out patients were advocated ( 9 , BACKGROUND The aim of this study was to evaluate the association between perioperative hyperglycemia and surgical site infections ( SSIs )  in patients undergoing mastectomy . METHODS In this nested case-control study , patients undergoing mastectomy from May 2004 to June 2006 , at the National Cancer Institute ( INCan ) , Mexico , were included .  Five blood glucose values were obtained for each patient . Patients were followed prospect ively by direct observation for at least 30 days . RESULTS A total of 260 patients were included . Patient characteristics were similar in cases and controls . Cases were older ( > 50 years ) ( P = .001 ) and were more frequently treated with concomitant chemoradiation ( P < .0001 ) than controls . Fifty cases ( 23.8 % ) developed an SSI . At least 1 measurement of blood glucose value > or = 150 mg/dL increased the risk for SSI ( odds ratio [ OR ] = 3.05 ; 95 % confidence interval [ CI ] = 1.5 to 6.3 ; P = .006 ) . Variables associated with SSI after logistic regression analysis included age > 50 years ( OR = 3.7 ; 95 % CI = 1.5 to 9.2 ; P = .005 ) , preoperative concomitant chemoradiation treatment ( OR = 2.8 ; 95 % CI = 1.4 to 5.8 , P = .0004 ) , and any blood glucose value > or = 150 mg/dL ( OR = 2.9 , 95 % CI = 1.2 to 6.2 ; P = .02 ) . CONCLUSION Postoperative SSI was a very frequent complication in this cohort . Our data indicate that higher blood glucose values are an independent risk factor for postoperative SSI . Preoperative concomitant chemoradiation and age > 50 years were also risk factors for developing an SSI in patients undergoing mastectomy Objective : This study sought to determine whether aggressive glycemic control ( 90–120 mg/dL ) would result in more optimal clinical outcomes and less morbidity than moderate glycemic control ( 120–180 mg/dL ) in diabetic patients undergoing coronary artery bypass graft ( CABG ) surgery . Summary of Background Data : Maintaining serum glucose levels between 120 and 180 mg/dL with continuous insulin infusions decreases morbidity in diabetic patients undergoing CABG surgery . Studies in surgical patients requiring prolonged ventilation suggest that aggressive glycemic control ( < 120 mg/dL ) may improve survival ; however , its effect in diabetic CABG patients is unknown . Methods : Eighty-two diabetic patients undergoing CABG were prospect ively r and omized to aggressive glycemic control ( 90–120 mg/dL ) or moderate glycemic control ( 120–180 mg/dL ) using continuous intravenous insulin solutions ( 100 units regular insulin in 100 mL : normal saline ) beginning at the induction of anesthesia and continuing for 18 hours after CABG . Primary end points were the incidence of major adverse events ( major adverse events = 30-day mortality , myocardial infa rct ion , neurologic events , deep sternal infections , and atrial fibrillation ) , the level of serum glucose , and the incidence of hypoglycemic events . Results : There were no differences in the incidence of major adverse events between the groups ( 17 moderate vs 15 aggressive ; P = 0.91 ) . Patients with aggressive control had a lower mean glucose at the end of 18 hours of insulin infusion ( 135 ± 12 mg/dL moderate vs 103 ± 17 mg/dL aggressive ; P < 0.0001 ) . Patients with aggressive control had a higher incidence of hypoglycemic events ( 4 vs 30 ; P < 0.0001 ) . Conclusions : In diabetic patients undergoing CABG surgery , aggressive glycemic control increases the incidence of hypoglycemic events and does not result in any significant improvement in clinical outcomes that can be achieved with moderate control . Clinical Trials.gov ( ID # NCT00460499 Background —This study sought to determine whether tight glycemic control with a modified glucose-insulin-potassium ( GIK ) solution in diabetic coronary artery bypass graft ( CABG ) patients would improve perioperative outcomes . Methods and Results —One hundred forty-one diabetic patients undergoing CABG were prospect ively r and omized to tight glycemic control ( serum glucose , 125 to 200 mg/dL ) with GIK or st and ard therapy ( serum glucose < 250 mg/dL ) using intermittent subcutaneous insulin beginning before anesthesia and continuing for 12 hours after surgery . GIK patients had lower serum glucose levels ( 138±4 versus 260±6 mg/dL ; P < 0.0001 ) , a lower incidence of atrial fibrillation ( 16.6 % versus 42 % ; P = 0.0017 ) , and a shorter postoperative length of stay ( 6.5±0.1 versus 9.2±0.3 days ; P = 0.003 ) . GIK patients also showed a survival advantage over the initial 2 years after surgery ( P = 0.04 ) and decreased episodes of recurrent ischemia ( 5 % versus 19 % ; P = 0.01 ) and developed fewer recurrent wound infections ( 1 % versus 10 % , P = 0.03 ) . Conclusions —Tight glycemic control with GIK  in diabetic CABG patients  improves perioperative outcomes , enhances survival , and decreases the incidence of ischemic events and wound complications Background This study compared intensive and conventional glycemic management strategies in diabetic patients receiving enteral nutrition after gastrectomy . Methods Diabetic patients ( n = 212 ) who underwent gastrectomy between September 2006 and March 2014 were r and omized to intensive glycemic ( IG ) management with continuous insulin infusion ( target glucose 4.4–6.1 mmol/l ( 80–110 mg/dl ) ) or conventional glycemic ( CG ) management with intermittent bolus insulin ( target glucose < 11.1 mmol/l ( < 200 mg/dl ) ) . Outcomes included blood glucose concentrations , insulin administration , and postoperative morbidity and mortality . Results Blood glucose levels were lower ( 5.4 ± 1.2 vs. 9.5 ± 1.8 mmol/l , P < 0.001 ) and mean insulin dose was higher ( 55 ± 15 vs.32 ± 16 units/day , P < 0.001 ) in the IG than in the CG group . Rates of severe hypoglycemia ( 7.5 vs. 0.9 % , P = 0.035 ) and achievement of target blood glucose ( 86.3 vs. 72.6 % , P = 0.023 ) were higher , while severe hyperglycemia rate was lower ( 1.9 vs. 11.3 % , P = 0.010 ) , in the IG group . Surgical site infection rate was lower in the IG group ( 4.7 vs. 13.2 % , P < 0.030 ) . Rates of other infective complications , bleeding , delayed gastric emptying , obstruction , hepatic dysfunction , renal dysfunction , and circulatory insufficiency were similar in the two groups . Conclusions Intensive glycemic control in diabetic patients receiving enteral nutrition after gastrectomy was associated with a lower surgical site infection rate but a higher hypoglycemia rate Background : A growing body of evidence suggests that hyperglycemia is an independent predictor of increased cardiovascular risk . Aggressive glycemic control in the intensive care decreases mortality . The benefit of glycemic control in noncardiac surgery is unknown . Methods : In a single-center , prospect i ve , unblinded , active-control study , 236 patients were r and omly assigned to continuous insulin infusion ( target glucose 100–150 mg/dl ) or to a st and ard intermittent insulin bolus ( treat glucose > 150 mg/dl ) in patients undergoing peripheral vascular bypass , abdominal aortic aneurysm repair , or below- or above-knee amputation . The treatments began at the start of surgery and continued for 48 h. The primary endpoint was a composite of all-cause death , myocardial infa rct ion , and acute congestive heart failure . The secondary endpoints were blood glucose concentrations , rates of hypoglycemia ( < 60 mg/dl ) and hyperglycemia ( > 150 mg/dl ) , graft failure or reintervention , wound infection , acute renal insufficiency , and duration of stay . Results : The groups were well balanced for baseline characteristics , except for older age in the intervention group . There was a significant reduction in primary endpoint ( 3.5 % ) in the intervention group compared with the control group ( 12.3 % ) ( relative risk , 0.29 ; 95 % confidence interval , 0.10–0.83 ; P = 0.013 ) . The secondary endpoints were similar . Hypoglycemia occurred in 8.8 % of the intervention group compared with 4.1 % of the control group ( P = 0.14 ) . Multivariate analysis demonstrated that continuous insulin infusion was a negative independent predictor ( odds ratio , 0.28 ; 95 % confidence interval , 0.09–0.87 ; P = 0.027 ) , whereas previous coronary artery disease was a positive predictor of adverse events . Conclusion : Continuous insulin infusion reduces perioperative myocardial infa rct ion after vascular surgery OBJECTIVE The optimal perioperative blood glucose range to improve surgical site infection ( SSI ) in surgical intensive care unit ( ICU ) patients remains unclear . We sought to determine whether the incidence of SSI is reduced by perioperative intensive insulin therapy ( IT ) . RESEARCH DESIGN AND METHODS Patients were r and omly assigned to receive perioperative intensive IT , with a target blood glucose range of 4.4–6.1 mmol/L , or intermediate IT , with a target blood glucose range of 7.7–10.0 mmol/L in the surgical ICU . We defined the primary end point as the incidence of SSI . RESULTS Study participants were r and omly assigned to glucose control with one of two target ranges : for 225 patients in the intermediate IT group or for 222 patients in the intensive IT group , respectively . No patients in either group became hypoglycemic ( < 4.4 mmol/L ) during their stay in the surgical ICU . In our series , the rate of SSI after hepato-biliary-pancreatic surgery was 6.7 % . Patients in the intensive IT group , compared with the intermediate IT group , had fewer postoperative SSIs ( 9.8 % vs. 4.1 % , P = 0.028 ) and a lower incidence of postoperative pancreatic fistula after pancreatic 
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These results were consistent both in patients with and those without diabetes , and in studies with moderately strict and very strict glucose control .
Conclusion : Stricter and lower blood glucose target levels of less than 150 mg/dl ( 8·3 mmol/l ) , using an intensive protocol in the perioperative period , reduce SSI with an inherent risk of hypoglycaemic events but without a significant increase in serious adverse events