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Researchers get a grip on how to control your blood sugar after a stroke



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Hyperglycaemia, as high level of glucose, is often in patients with acute ischemic stroke and is associated with poorer outcomes compared to normal blood glucose levels. Animal studies also indicated an effect of high blood sugar on the reduction of stroke injury. Stroke experts have discussed whether intensive glucose management to acute ischemic stroke leads to better outcomes but a new study into JAMA finds that aggressive methods are no better than standard approaches. The study was supported by the National Institute for Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.

"After dozens of years of uncertainty about how your blood sugar can manage in acute stroke patients, we finally have strong clinical evidence that aggressively lowering patient outcomes does not improve," said Walter Koroshetz, M.D., director of NINDS.

The Stroke Hyperglycemia Insulin Network Effort (SHINE) study, a large, multisite clinical study led by Karen C. Johnston, MD, Professor of Neurology and Associate Vice President of Clinical & Translational Research at Virginia University, Charlottesville , compared two commonly used glucose control strategies in ischemic stroke patients. More than 1100 patients underwent intensive glucose management, requiring the use of intravenous insulin delivery to bring blood glucose to 80-130 mg / dL, as standard glucose control with insulin targets, which were intended to be glucose below 180 mg / dL, up to 72 hours. After 90 days, patients were evaluated for outcomes, including disability, neurological function, and health.

The results suggested that the two treatments were equally effective in restoring the patients' strokes. After 90 days, about 20% of patients showed favorable outcomes, regardless of whether they received intensive or standard treatment.

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

The study stopped early when a pre-planned interim analysis showed that intensive glucose control did not improve outcomes in comparison to standard treatment.

"We found that the extra risk they were associated with aggressive treatment was not worth it," said Dr. Johnston. "We are so grateful to the patients and research teams from across the country who helped us to answer this important question. As a result, their participation will benefit the whole world."

This study was supported by NINDS & # 39; Neurological Emergencies Treatment Trials (NETT) Network, a system of research settings that are dedicated to medical emergencies, including strokes. The study was also conducted in collaboration with StrokeNet & # 39; of NINDS, that is a network of hospitals that provides sources for multi-site clinical studies that evaluate new therapies to treat strokes.

More research is needed to better understand the role of glucose in the recovery time of a stroke and to identify extra treatments to improve outcomes in hyperglycemic stroke applications. Future studies will also determine if high blood sugar is a cause as a result of unfavorable stroke outcomes.


Intensive IV blood sugar control does not improve stroke outcome


More information:
Johnston et al. "Intense versus standard treatment of hyperglycaemia and functional outcome in patients with acute ischemic stroke," JAMA, July 23, 2019. DOI: 10.1001 / jama.2019.9346

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