title: [Moderate control of hyperglycemia after acute stroke in the intensive care unit].
abstract: Hyperglycemia following an ischemic stroke has been associated with poor clinical outcome. We retrospectively assessed the effect of moderately controlled plasma glucose (correction from 135mg/dl) compared to conservative treatment (correction from 200 mg/dl), as regards neurological evolution, duration of hospitalization, at discharge and at 30 days post-discharge, also complications associated with the treatment in patients admitted to the intensive care unit. We studied 208 patients, 103 (24% diabetics) with moderate therapy and 105 (23% diabetics) with conservative treatment. The average blood glucose during hospitalization tended to be lower with the moderate treatment with no statistic significance (129 ± 30 vs. 138 ± 31 mg/dl; p = 0.06). The difference was significant in non-diabetics (119 ± 24 vs. 128 ± 24 mg/dl; p < 0.05), being even more pronounced in those non-diabetics with moderate to severe neurological deficit on admission (116 ± 23 vs. 130 ± 23 mg/dl; p < 0.01). Patients admitted with moderate to severe neurological deficit and treated with moderate regime had a better outcome at discharge and at 30 days (NIHSS variation: high 2.1 ± 2.6 vs. 3.4 ± 3; 30 days: 3.2 ± 3 vs. 4.8 ± 3; p < 0.01). The duration of hospitalization was lower in the moderate treatment group (5.7 vs. 9.2 days, p < 0.05), with no significant difference showing in the incidence of hypoglycemia in either group. In conclusion, moderate control of blood glucose in ACVi patients relates to an improved neurological outcome in those admitted with moderate to severe neurological deficits (NIH scale = 4), with a reduced hospital stay, and no substantial increase of hypoglycemia episodes.
authors.affiliation: Departamento de Medicina Interna, Instituto de Investigaciones Neurológicas Dr. Raúl Carrea, FLENI, Buenos Aires, Argentina.
authors.forename: Néstor A
authors.initials: NA
authors.lastname: Wainsztein
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Pujol Lereis
authors.forename: Federico J
authors.initials: FJ
authors.lastname: Capparelli
authors.forename: Alejandro
authors.initials: A
authors.lastname: Hlavnika
authors.forename: María F
authors.initials: MF
authors.lastname: Díaz
authors.forename: Ramón E
authors.initials: RE
authors.lastname: Leiguarda
authors.forename: Sebastián F
authors.initials: SF
authors.lastname: Ameriso
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D048909:Diabetes Complications / Q000188:drug therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: hyperglycemia; insulin; stroke
vernacular_title: Control moderado de hiperglucemia luego de infarto cerebral agudo en la unidad de cuidados intensivos.