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

Jacek Staszewski, Bogdan Brodacki, Jerzy Kotowicz, Adam Stepien
Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association 2011, 20 (2): 150-4
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 values dropped to 4.9±0.5 mmol/L (88±9 mg/dL) and 5.5±0.45 mmol/L (99±8 mg/dL), respectively (P < .01). Two patients from the ISI group (8%) required IV glucose infusion for symptomatic hypoglycemia. There was no significant between-group difference in neurologic status at admission (median NIHSS score, 10±3 vs 10±2) and 24 hours later (8±2 vs 9±3). At 30 days, the median NIHSS score was 4±3 in the ISI group and 7±4 in the CG (P=.04). Our findings indicate that in nondiabetic AIS patients with mild hyperglycemia, IV insulin therapy aimed at maintaining strict glycemic control (PGL 4.5-7.0 mmol/L [81-126 mg/dL]) is relatively safe and may improve stroke outcome.

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