The effectiveness of active blood glucose management on the prevention of further CVA complications within 24 hours in adult patients: a systematic review.
: The objective of this systematic review was to determine the effectiveness of active blood glucose management within 24 hours of the occurrence of a cerebrovascular accident (CVA). The search strategy covered all major databases and including MEDLINE, CINAHL, Current Contents, Embase and the Cochrane Library. Only one study met the review inclusion criteria and is reported in this paper. Results were summarised by a narrative discussion. The study used a randomised controlled trial design. In this study, 50 acute stroke patients with mild to moderate hyperglycemia were randomised to receive either a 24-hour infusion of 0.9% saline or a glucose potassium insulin (GKI) infusion. Twenty-five patients received GKI, 1 of whom required intravenous glucose for symptomatic hypoglycemia. Plasma glucose levels were not significantly lower in the GKI group throughout the infusion period. Four week mortality in the GKI group was 7 (28%), compared with 8 (32%) in the control group. The results from this included study confirming that the GKI infusion in mild to moderate hyperglycemia following acute stroke is a safe, practical and pragmatic intervention which effectively lowers the plasma glucose level to within the normal range without significant risk of hypoglycemia, cardiovascular adverse events or excess mortality at 4 weeks. The small numbers involved in this pilot study mean that an assessment of the clinical effectiveness of GKI therapy is impossible at this early stage. Therefore, at present there is little evidence based knowledge on active glucose modulation after stroke.
La Trobe University, School of Nursing and Midwifery, Bundoora, Victoria 3086, Email: ayeayegyi@yahoo.com, Ph: (08) 222 2546, 0411 341 783.
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