Research from UT Southwestern Medical Center shows patients with Type 2 diabetes who have an acute ischemic stroke have equally favourable results when their blood sugar levels are controlled with intermittent insulin shots compared with continuous insulin treatment using an IV.
The study is the first evidence-based validation of glucose-control guidelines for blood sugar management in patients with hyperglycaemia after stroke, researchers say.
Dr Christiana Hall, associate professor of neurology and neurotherapeutics at UT Southwestern’s Peter O’Donnell Jr. Brain Institute, says: “The study upholds the most common standard of care practice utilised over the years. It’s what our guidelines recommend, even though we never had strong data to support them.
“With intermittent insulin shots there is less chance for blood sugar going too low.”
People with hyperglycaemia, or high levels of glucose, who have an acute stroke may have greater mortality, stroke severity, and functional impairment when compared with those with normal blood sugar.
Doctors across the world have debated whether intensive glucose management, which requires the use of IV insulin to bring blood sugar levels down to 80-130 mg/dL, or standard glucose control using insulin shots, which aims to get glucose below 180 mg/dL, might lead to better outcomes after stroke.
Results from the Stroke Hyperglycaemia Insulin Network Effort (SHINE) study, a multisite clinical study of some 1,100 patients, provide a clear answer: Intense glucose therapy increased the risk of very low blood glucose (hypoglycaemia) and required a higher level of care, such as increased supervision from nursing staff, compared with standard treatment.
However, recovery from stroke in the two groups of study patients was the same three months after treatment.
Seventy sites across the US participated in the trial, including UT Southwestern and Parkland Memorial Hospital in Dallas.
Participants were required to have a history of Type 2 diabetes or blood glucose greater than 150 and be enrolled in the randomised trial within 12 hours of stroke onset.
There were two treatment groups: patients receiving intensive glucose management and those undergoing standard glucose control, both for up to 72 hours.
The study was supported with funding from the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.
It was published in the Journal of the American Medical Association.