A Randomised, Controlled Pilot Study to Investigate the Potential Benefit of Intervention with Insulin in Hyperglycaemic Acute Ischaemic Stroke PatientsWalters M.R. · Weir C.J. · Lees K.R.
University Department of Medicine and Therapeutics, Western Infirmary, Glasgow, UK
Background: Hyperglycaemia on presentation with acute ischaemic stroke (AIS) is associated with poor outcome, but intervention is unproven. We investigated the safety and tolerability of one method of glycaemic control. Methods: Patients within 24 h of AIS and plasma glucose 8–20 mmol/l were randomised to receive either rigorous glycaemic control (RC) or standard management (SM) for 48 h. RC comprised i.v. insulin at a variable rate adjusted for target glucose concentration of 5–8 mmol/l, and intravenous crystalloid. The SM group received intravenous crystalloid alone in an open-label design. Results: Thirteen patients were randomised to RC and 12 to SM (age 75 ± 6.2 years; 40% male; 20% lacunar stroke; time to treatment 8 ± 6.1 h; plasma glucose 10.6 ± 0.9 mmol/l; known diabetes 52%; NIHSS 8, range 2–28). The glucose concentration-time curve was reduced in the RC group (AUC 324 ± 15 versus 385 ± 28 h·mmol/l, p = 0.04). By 48 h, plasma glucose in both groups was 6.8 ± 1.1 and 7.5 ± 1.3 mmol/l respectively, but mean hourly insulin requirements in the RC group had dropped from 3.25 ± 0.32 units to 1.25 ± 0.5 units (p < 0.01). One transient episode of hypoglycaemic symptoms occurred in the RC group. Conclusion: Glycaemic control with sliding scale insulin for 48 h is feasible and well-tolerated after AIS. Treatment after 48 h may be unnecessary.
© 2006 S. Karger AG, Basel
University Department of Medicine and Therapeutics
Glasgow, G11 6NT (UK)
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Received: August 15, 2005
Accepted: January 30, 2006
Published online: May 9, 2006
Number of Print Pages : 7
Number of Figures : 2, Number of Tables : 2, Number of References : 23
Vol. 22, No. 2-3, Year 2006 (Cover Date: July 2006)
Journal Editor: Bogousslavsky, J. (Lausanne)
ISSN: 1015–9770 (print), 1421–9786 (Online)
For additional information: http://www.karger.com/CED