Intensive glucose control after acute ischemic stroke does not improve functional outcomes
Background: Higher glucose immediately following acute ischemic stroke is known to be associated with poor outcomes. Patients with elevated glucoses in the aftermath of an acute ischemic stroke are more likely to have expansion of ischemic area and are more likely to have hemorrhagic conversion.
Dr. Adam Fritz
Study design: Randomized, controlled trial, with blinded outcome assessment.
Setting: 63 sites in the United States.
Synopsis: A total of 1,151 patients were randomized to either intensive (goal blood glucose, 80-130 mg/dL) or standard (goal blood glucose, 80-179 mg/dL) glucose control for up to the first 72 hours after presenting with acute ischemic stroke. Patients in the intensive control group were given continuous IV insulin and patients in the standard control group were given subcutaneous sliding. There was no difference between groups (intensive vs. standard) with regards to the primary outcome, which was the percentage of patients who achieved a modified Rankin Score at 90 days of 0-2 (20.5% vs 21.6%; adjusted relative risk, 0.97; 95% confidence interval, 0.87-1.08; P = .55). Severe hypoglycemia (blood glucose of less than 40 mg/dL) occurred in the intensive control group only. The American Heart Association/American Stroke Association guidelines support target blood glucose of 140-180 mg/dL, though limited evidence to support this guideline is noted.
Bottom line: Patients who underwent intensive glucose control regimens following acute ischemic stroke did not have significantly different functional outcomes at 90 days than those who had standard glucose control therapy.
Citation: Johnston KC et al. Intensive vs. standard treatment of hyperglycemia and functional outcome in patients with acute ischemic stroke: The SHINE randomized clinical trial. JAMA. 2019 Jul 23/30;322(4):326-35.
Dr. Fritz is assistant professor of medicine and the director of hospitalist operations at St. Louis University School of Medicine.
