Intensive glucose control offers no benefit in acute ischemic stroke

  • Johnston KC & al.
  • JAMA
  • 23 Jul 2019

  • International Clinical Digest
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Takeaway

  • Among patients with acute ischemic stroke and hyperglycemia, intensive vs standard glucose control for up to 72 hours yields no difference in 90-day functional outcome.

Why this matters

  • Hyperglycemia is present in ~40% of patients with acute ischemic stroke and associated with worse outcomes.

Study design

  • Randomized 63-site trial of 1151 patients (80% with diabetes diagnosis) with hyperglycemia (glucose >110 mg/dL with diabetes; ≥150 mg/dL without) enrolled ≤12 hours from acute ischemic stroke onset.
  • Groups: intensive glycemic management (target 80-130 mg/dL via intravenous insulin) or standard (target 80-179 mg/dL using insulin injections) for ≤72 hours poststroke.
  • Favorable outcome: 90-day modified Rankin Scale score 0-2, depending on baseline NIH Stroke Scale score.
  • Funding: NIH; Medical Decision Network LLC.

Key results

  • Mean glucose: 118 mg/dL with intensive vs 179 mg/dL with standard treatment.
  • Treatment stopped early for hypoglycemia/other adverse events in 11.2% intensive vs 3.2% standard.
  • Favorable outcomes occurred in 20.5% intensive vs 21.6% standard (adjusted relative risk, 0.97; P=.55).
  • Severe hypoglycemia (

Limitations

  • 6 sites enrolled 42% of patients.
  • Possible selection bias.
  • No canalization data.
  • More frequent glucose checks in intensive group (every 1-2 vs 3 hours).