Intravenous insulin therapy in the maintenance of strict glycemic control in nondiabetic acute stroke patients with mild hyperglycemia

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
Jacek StaszewskiAdam Stepien

Abstract

Several reports indicate that mild hyperglycemia (plasma glucose level [PGL] ≥7.0 and ≤10.0 mmol/L [≥126 and ≤180 mg/dL]) is associated with poor prognosis in nondiabetic patients who sustain acute ischemic stroke (AIS). Insulin therapy to maintain PGL <7.0 mmol/L (<126 mg/dL) has been reported to be beneficial in critically ill patients, but the safety and efficacy of this approach in patients with AIS are not well established. In a prospective, open-label study, 50 consecutive nondiabetic patients with AIS admitted within 12 hours of ictus and with a PGL ≥7.0 and ≤10.0 mmol/L (≥126 and ≤180 mg/dL) were randomized to receive either a 24-hour intravenous (IV) insulin infusion (ISI) adjusted to maintain PGL within 4.5-7.0 mmol/L (81-126 mg/dL) (ISI group; n=26) or treatment with subcutaneous insulin if PGL was >10.0 mmol/L (>180 mg/dL) (control group [CG]; n=24). Patients' neurologic status was assessed based on National Institutes of Health Stroke Scale (NIHSS) score at admission, 24 hours and 30 days. The 2 groups did not differ in terms of risk factors for stroke. The mean PGL measured at admission was 8.25±0.9 mmol/L (149±16 mg/dL) in the ISI group and 8.1±0.8 mmol/L (146±14 mg/dL) in the CG (P=.8). After 24 hours, these val...Continue Reading

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