Subjecting acute ischemic stroke patients to continuous tube feeding and an intensive computerized protocol establishes tight glycemic control.
BACKGROUND
Tight glycemic control (TGC) after ischemic stroke may improve clinical outcome but previous studies failed to establish TGC, principally because of postprandial glucose surges. The aim of the present study was to investigate if safe, effective and feasible TGC can be achieved with continuous tube feeding and a computerized treatment protocol.


METHODS
We subjected ten acute ischemic stroke patients with admission hyperglycemia (glucose >7.0 mmol/l (126.0 mg/dl)) to continuous tube feeding and a computerized intensive protocol with insulin adjustments every 1-2 h. Two groups of regularly fed patients from a previous study with a similar design served as controls. These groups comprised hyperglycemic patients treated according to an intermediate protocol with insulin adjustments at standard intervals (N = 13), and normoglycemic controls treated according to standard care (N = 15). The primary outcome was the percentage of time within target (4.4-6.1 mmol/l (79.2-109.8 mg/dl)). Secondary outcome was the number of patients with hypoglycemic episodes (glucose <3.0 mmol/l (54.0 mg/dl)).


RESULTS
Median time within target was 55% in the continuously fed intensive group compared to 19% in the regularly fed intermediate group, and 58% in normoglycemic controls. Hypoglycemic episodes occurred in 20% of patients in the continuously fed group-lowest glucose level 2.4 mmol/l (43.2 mg/dl). In contrast, in the regularly fed group, this was 31%-lowest glucose level 1.6 mmol/l (28.8 mg/dl).


CONCLUSIONS
TGC after acute ischemic stroke is feasible with continuous tube feeding and a computerized intensive treatment protocol. Although glycemic control is associated with hypoglycemia, no severe hypoglycemia occurred in the continuous tube feeding group.
Kruyt
N D
ND
Department of Neurology, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, the Netherlands. N.D.Kruijt@amc.uva.nl
Biessels
G J
GJ
Vriesendorp
T M
TM
Devries
J H
JH
Hoekstra
J B L
JB
Elbers
P W
PW
Kappelle
L J
LJ
Portegies
P
P
Vermeulen
M
M
Roos
Y B W E M
YB
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism*; D002544:Cerebral Infarction / Q000097:blood / Q000628:therapy*; D015331:Cohort Studies; D003422:Critical Care; D019091:Critical Pathways; D004750:Enteral Nutrition; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000628:therapy*; D007003:Hypoglycemia / Q000097:blood; D008297:Male; D008875:Middle Aged; D013813:Therapy, Computer-Assisted
D001786:Blood Glucose