title: Intravenous insulin therapy in the maintenance of strict glycemic control in nondiabetic acute stroke patients with mild hyperglycemia.
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 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.
authors.affiliation: Clinic of Neurology, Military Medical Institute, Warsaw, Poland. staszej@amwaw.edu.pl
authors.forename: Jacek
authors.initials: J
authors.lastname: Staszewski
authors.forename: Bogdan
authors.initials: B
authors.lastname: Brodacki
authors.forename: Jerzy
authors.initials: J
authors.lastname: Kotowicz
authors.forename: Adam
authors.initials: A
authors.lastname: Stepien
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects*; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011044:Poland; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin