Intensive glycemic control is not better than standard treatment for hyperglycemia, reveals a study

Hyperglycemia, or high glucose, is common in patients with acute ischemic stroke and is badociated with an adverse outcome compared to normal blood glucose. Animal studies have also shown an effect of hyperglycemia on the worsening of stroke-related trauma. Stroke experts debated whether intensive management of blood glucose after acute ischemic stroke resulted in better outcomes. JAMA notes that aggressive methods are not better than standard approaches. The study was funded by the National Institute of Neurological Disorders and Stroke (NINDS), which is part of the National Institutes of Health.

After decades of uncertainty about how to manage blood sugar in patients with acute stroke, we finally have strong clinical evidence that aggressive lowering does not improve outcomes for patients . "

Walter Koroshetz, M.D., Director of NINDS

The SHINE study (Stroke Hyperglycemia Insulin Network Effort) is a large, multi-site clinical study led by Karen C. Johnston, Professor of Neurology and Associate Vice President of Clinical and Translational Research at the University of Virginia, at Charlottesville, compared with two glucose control strategies in patients with ischemic stroke. More than 1100 patients underwent intensive glucose management, which required the use of intravenous insulin administration to bring the blood sugar level to 80-130 mg / dL, or standard glycemic control with the help of insulin doses, which aimed to achieve a glucose level below 180 mg / dL. , for a maximum of 72 hours. After 90 days, patients were evaluated for outcomes, including disability, neurological function, and quality of life.

The results suggested that both treatments were equally effective in helping patients recover from their strokes. After 90 days, about 20% of the patients showed favorable results, whether they received intensive or standard treatment.

Intensive glucose treatment increased the risk of very low blood glucose (hypoglycaemia) and required a higher level of care, such as increased nursing supervision, compared to standard therapy.

The study was stopped early when a planned interim badysis revealed that intensive blood glucose control did not improve the results compared to standard treatment.

"We found that the extra risks badociated with aggressive treatments were not worth it," said Dr. Johnston. "We are very grateful to patients and research teams across the country who have helped us answer this important question, and through their participation, patients around the world will benefit."

This study was funded by NINDS 'Network of Neurological Emergency Treatment Trials (NETT), a system of research institutions dedicated to emergency medical problems, including stroke. The study was also conducted in collaboration with NINDS & # 39; StrokeNet, a network of hospitals providing resources for multi-site clinical trials evaluating new treatments for the treatment of stroke.

Further research is needed to better understand the role of glucose in recovery from stroke and to identify additional treatments to improve outcomes in hyperglycemic patients. Future studies will also determine if hyperglycemia is the cause or the effect of adverse ACN effects.