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Comment & Response
July 2, 2019

Glucose Control in the Perioperative Period—Reply

Author Affiliations
  • 1Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, Minnesota
JAMA. 2019;322(1):82-83. doi:10.1001/jama.2019.5852

In Reply In response to Dr Finucane’s query about our presentation on the risks and benefits of intensive glucose control,1 we would like to point out that we do not advocate intensive glucose control in the perioperative period. We have, in fact, alluded to studies showing the potential harm of intensive glucose control in the intraoperative period,2 and throughout the Clinical Update, we advocated for a target blood glucose of less than 180 mg/dL and avoidance of hypoglycemia. Our comment that “good” (not intensive) glucose control is likely to be beneficial was based on a meta-analysis by Sathya et al,3 which showed reduced postoperative mortality (odds ratio, 0.48 [95% CI, 0.24-0.76]) and stroke (odds ratio, 0.61 [95% CI, 0.38-0.98]) when the perioperative glycemic target was 150 to 200 mg/dL compared with greater than 200 mg/dL. This reference had to be deleted from the final version of the article for space considerations.