Background
Methods
Search strategy
Study selection and data extraction
First author | Type of surgery | Patient type | Sample | Time of intervention | Insulin infusion protocol | Mean age (mean ± SD, year) | Male (%) | BMI(mean ± SD) | |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
TGC/CGC | TGC | CGC | TGC | CGC | TGC | CGC | |||||||
Van Den et al. (2001) | various surgeries | adult | 1548(765/783) | postoperative | Yes | 63.4 ± 13.6 | 62.2 ± 13.9 | 71 | 71 | 26.2 ± 4.4 | 25.8 ± 4.7 | ||
Salah M et al. (2013) | cardiac surgery | adult | 100(50/50) | Intra + post operative | Yes | 46.0 ± 9.0 | 49.0 ± 8.0 | 60 | 70 | 28.0 ± 0.8 | 26.0 ± 2.0 | ||
Konstantinos et al. (2013) | cardiac surgery | adult | 212(105/107) | postoperative | Yes | 64.9 ± 11.5 | 66.9 ± 11.1 | 66 | 68 | 27.8 ± 4.4 | 28.0 ± 3.9 | ||
Amisha et al. (2017) | liver transplantation | adult | 164(82/82) | postoperative | Yes | 58.1 ± 8.0 | 56.9 ± 7.6 | 65 | 65 | 30.3 ± 6.0 | 30.0 ± 6.6 | ||
Rehong Zheng et al. (2010) | cardiac surgery | adult | 100(50/50) | Intra + post operative | Yes | 43.3 ± 11.7 | 44.0 ± 11.5 | 48 | 46 | ||||
Raquel Pei Chen Chan et al. (2009) | cardiac surgery | adult | 108(54/55) | Intra + post operative | Yes | 57.0 ± 12.0 | 58 ± 12 | 43 | 56 | 24.0 ± 3.4 | 26.0 ± 4.9 | ||
Shou-gen Cao et al. (2011) | elective radical gastrectomy with D2 lymphadenectomy | adult | 248(125/123) | postoperative | Yes | 58.5 ± 8.1 | 59.9 ± 7.6 | 67 | 64 | 20.8 ± 2.1 | 21.2 ± 2.1 | ||
Shou-gen Cao et al. (2011) | elective radical gastrectomy with D2 lymphadenectomy | adult | 179(92/87) | postoperative | Yes | 58.2 ± 6.3 | 59.4 ± 7.3 | 30 | 34 | 21.1 ± 2.0 | 22.2 ± 2.6 | ||
Takehiro Okabayashi et al. (2014) | hepatectomy or pancreatectomy | adult | 447(222/225) | Intra + post operative | No | 66.7 ± 10.1 | 66.4 ± 10.4 | 64 | 67 | 23.3 ± 3.6 | 23.1 ± 3.4 | ||
Ehab A. Wahby et al. (2016) | cardiac surgery | adult | 135(67/68) | Intra + post operative | No | 54.99 ± 6.49 | 56.40 ± 7.79 | 73 | 68 | ||||
Federico Bilotta et al. (2009) | Neurosurgical | adult | 483(241/242) | postoperative | Yes | 57.3 ± 11.9 | 56.9 ± 12.7 | 63 | 52 | ||||
Shalin P. Desai et al. (2012) | cardiac surgery | adult | 189(91/98) | postoperative | Yes | 62.5 ± 10.2 | 62.8 ± 9.5 | 89 | 80 | ||||
Federico Bilotta et al. (2007) | Intracranial Aneurysm Clipping | adult | 78(40/38) | Intra + post operative | Yes | 53.0 ± 16.0 | 52.0 ± 15.0 | 30 | 32 | ||||
Michael SD Agus et al. (2012) | cardiac surgery | birth to 36 months | 980(490/490) | postoperative | Yes | 4.3(1.8–9.7) months | 4.9(2.3–10.8) months | 51 | 56 | ||||
Harold L et al. (2011) | cardiac surgery | adult | 82(40/42) | Intra + post operative | Yes | 63 ± 9 | 65 ± 9 | 65 | 76 | ||||
First author | History of diabetes (%) | Baseline blood glucose (mean ± SD, mg/dL) | Target blood glucose(mean ± SD, mg/dL) | Trigger blood glucose(mean ± SD, mg/dL) | Postoperatively maintain blood glucose(mean ± SD, mg/dl) | Glucocorti-coids used | postoperative follow-up | Jadad Score | |||||
TGC | CGC | TGC | CGC | TGC | CGC | TGC | CGC | TGC | CGC | ||||
Van Den et al. (2001) | 13 | 13 | 80–110 | 180–200 | 110 | 215 | 103 ± 19 | 153 ± 33 | No | in-hospital | 6 | ||
Salah M et al. (2013) | 100 | 100 | 80–110 | 110–180 | 110 | 180 | No | 6 months | 2 | ||||
Konstantinos et al. (2013) | 26 | 31 | 120–160 | 161–200 | 160 | 200 | 153.9 ± 13.9 | 173.9 ± 17.4 | No | 30 days or in-hospital | 1 | ||
Amisha et al. (2017) | 28 | 32 | 140 | 180 | 146.4 ± 16.4 | 178.8 ± 24.0 | Yes | 1 year | 4 | ||||
Rehong Zheng et al. (2010) | 0 | 0 | 78.4 ± 3.8 | 77.5 ± 2.6 | 70–110 | 110 | No | 2 | |||||
Raquel Pei Chen Chan et al. (2009) | 113.4 ± 42.5 | 138 ± 75 | 80–130 | 160–200 | 130 | 200 | 126.7 ± 10.8 | 168.2 ± 28.3 | No | 30 days | 3 | ||
Shou-gen Cao et al. (2011) | 0 | 0 | 99.0 ± 14.4 | 95 ± 13 | 80–110 | < 200 | 110 | 200 | 94.5 ± 15.3 | 184.0 ± 16.7 | No | 28 days | 2 |
Shou-gen Cao et al. (2011) | 100 | 100 | 122.4 ± 10.8 | 126 ± 13 | 80–110 | 180–215 | 110 | 215 | 99 ± 14.4 | 178.2 ± 18 | No | 28 days | 1 |
Takehiro et al. (2014) | 24 | 26 | 80–110 | 140–180 | 110 | 180 | No | 1 day | 2 | ||||
Ehab A. Wahby et al. (2016) | 100 | 100 | 164.1 ± 12.1 | 167 ± 17 | 110–149 | 150–180 | No | weaned from mechanical ventilation | 2 | ||||
Federico Bilotta et al. (2009) | 10 | 10 | 179 ± 32 | 181 ± 29 | 80–110 | 180–215 | 110 | 215 | 92.3 ± 2.5 | 143.3 ± 20.3 | Yes | 6 months | 6 |
Shalin P. Desai et al. (2012) | 41 | 45 | 90–120 | 121–180 | No | 30 days | 1 | ||||||
Federico Bilotta et al. (2007) | 10 | 11 | 80–120 | 80–220 | Yes | 6 months | 5 | ||||||
Michael SD Agus et al. (2012) | 0 | 0 | 80–110 | 110 | 112(104–120) | 121(109–136) | Yes | 30 days | 6 | ||||
Harold L et al. (2011) | 100 | 100 | 161 ± 50 | 151 ± 35 | 80–120 | 120–180 | 120 | 180 | 103 ± 17 | 135 ± 12 | No | 30 days | 1 |
Outcomes definition and quality assessment
Quality of the included studies
Data synthesis and analysis
Sample size calculation and power analysis
Results
Study selection and characteristics
Primary outcomes
Risk of postoperative infection
TGC | CGC | Overall event rates (%) | M-H pooled RR | Heterogeneity | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Events | Studies | N+(%) | Total | N+(%) | Total | RR/ SMD (95%CI) |
p
|
I
2
(%)
|
p
| |
Infection | 231(9.4%) | 2464 | 392(15.8%) | 2488 | 12.6% | 0.586(0.504, 0.680) | < 0.001 | 3.9 | 0.407 | |
Sepsis | 48(2.7%) | 1753 | 82(4.7%) | 1763 | 3.7% | 0.594(0.418, 0.842) | 0.003 | < 0.001 | 0.945 | |
Pneumonia | 22(2.0%) | 1079 | 31(2.9%) | 1078 | 2.5% | 0.692(0.400, 1.196) | 0.187 | < 0.001 | 0.511 | |
Urinary tract infection | 36(3.6%) | 988 | 43(4.4%) | 980 | 4.0% | 0.843(0.548, 1.297) | 0.437 | < 0.001 | 0.682 | |
Wound infection | 54(4.6%) | 1186 | 86(7.2%) | 1188 | 6.1% | 0.620(0.422, 0.910) | 0.015 | 18.8 | 0.287 | |
Short-term mortality | 85(3.8%) | 2233 | 122(5.4%) | 2259 | 4.6% | 0.692(0.527, 0.909) | 0.008 | < 0.001 | 0.769 | |
Any mortality | 159(6.3%) | 2514 | 204(8.0%) | 2539 | 7.2% | 0.792(0.653, 0.960) | 0.018 | < 0.001 | 0.738 | |
Neurological dysfunction | 8(1.1%) | 752 | 18(2.4%) | 761 | 1.7% | 0.499(0.219, 1.137) | 0.098 | < 0.001 | 0.651 | |
Acute renal failure | 46(3.3%) | 1413 | 78(5.4%) | 1439 | 4.3% | 0.610(0.359, 1.038) | 0.068 | 16.0 | 0.312 | |
Hypoglycemia | 467(22.3%) | 2097 | 233(11.0%) | 2118 | 16.6% | 3.145(1.928, 5.131) | < 0.001 | 81.4 | < 0.001 | |
Severe hypoglycemia | 34(2.8%) | 1207 | 8(0.7%) | 1210 | 1.7% | 3.821(1.796, 8.127) | < 0.001 | < 0.001 | 0.894 | |
ICU stay | −0.428(−0.833, −0.022) | 0.039 | 96.6 | < 0.001 | ||||||
Mechanical ventilation | −0.275(−0.695,0.146) | 0.201 | 96.9 | < 0.001 | ||||||
LOS | −0.233(−0.496,0.030) | 0.082 | 85.4 | < 0.001 |