Study Doesn't Support Intensive Glucose Control in Patients with Stroke and Hyperglycemia

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Intensive glucose control doesn't confer better functional outcomes than standard control in patients with stroke and hyperglycemia, a JAMA study finds.

Nearly 1200 patients with acute ischemic stroke and hyperglycemia (glucose levels above 6.1 mmol/L with type 2 diabetes, at or above 8.3 mmol/L without diabetes) were randomized to receive either intensive or standard glucose control for up to 72 hours. The intensive group received continuous IV insulin to maintain a blood glucose level of 80 to 130 mg/dL. The standard treatment group received subcutaneous insulin every 6 hours to maintain levels between 80 and 179 mg/dL.

The proportion of patients with a favorable functional outcome score at 90 days did not differ significantly between the two groups, at roughly 21%. Severe hypoglycemia occurred in 2.6% of patients in the intensive control group and in none of the standard group.

The authors conclude: "These findings do not support using intensive glucose control in this setting."