Close Control of Blood Glucose following Acute CVA.
Date First Published:
February 8, 2007
Last Updated:
February 8, 2007
Report by:
Tom Leckie, Specialist Registrar in Emergency Medicine (Manchester Royal Infirmary)
Three-Part Question:
in [patients with elevated blood glucose immediately following Stroke] does [close control of Blood Glucose] [improve outcome]
Clinical Scenario:
A patient presents to the Emergency Department with acute onset of a left sided hemiplegia. The blood glucose is measured and found to be 12mmol/l. Would using insulin to control the blood glucose closely improve the patients outcome?
Search Strategy:
OVID medline 1950 to January Week 5 2007
Search Details:
([exp Cerebrovascular Accident/ or cva.mp/ or stroke.mp] and [exp Blood Glucose/ or exp Hyperglycaemia/ or hyperglycaemia.mp] and [exp Insulin/ or insulin.mp]) LIMIT humans and english language
Outcome:
210 papers were found with 1 relevant to the question
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Glucose potassium insulin infusions in the treatment of acute stroke patients with mild to moderate hyperglycemia: the Glucose Insulin in Stroke Trial (GIST). Scott JF. Robinson GM. French JM. O'Connell JE. Alberti KG. Gray CS. 1998 UK - Sunderland | >18 within 24hrs of acute CVA with a plasma glucose of 7.0 to 17 mmol/L. Exclusions - Heart Failure, renal failure, anaemia, pneumonia, coma, previous disabling stroke, dementia, insulin treated diabetes |
Randomised to treatment with 10% glucose containing 20mmol KCl and 16U insulin in 500ml or normal saline. Infused at 100 ml per hour for first 24 hrs BM's between 4 and 7 mmol/L were aimed for in the treatment group. |
Mortality at 4 weeks | Treatment group 7/25 (28% ) Control 8/25 (32%) | Small numbers. Non blinded. Short treatment period. |
| Stroke scoring | No significant difference |
Author Commentary:
Although there is evidence that hyperglycaemia is associated with a poor outcome after stroke, there is no data showing that the use of a DIGAMI type regimen to closely control Blood Glucose improves outcome. More powerful studies are required to answer this question.
Bottom Line:
There is no evidence of benefits from close control of blood glucose in moderately hyperglycaemic stroke patients. Local policies should be adhered to.
References:
- Scott JF. Robinson GM. French JM. O'Connell JE. Alberti KG. Gray CS.. Glucose potassium insulin infusions in the treatment of acute stroke patients with mild to moderate hyperglycemia: the Glucose Insulin in Stroke Trial (GIST).