Intensive Versus Standard Treatment of Hyperglycemia in Acute Ischemic Stroke Patient: A Randomized Clinical Trial Subgroups Analysis

Author:

Torbey Michel T.1ORCID,Pauls Qi2,Gentile Nina3ORCID,Falciglia Mercedes4ORCID,Meurer William5ORCID,Pettigrew Creed L.6ORCID,Durkalski Valerie L.2,Bleck Thomas7ORCID,Bruno Askiel8ORCID,

Affiliation:

1. Department of Neurology, University of New Mexico, Albuquerque (M.T.T.).

2. Department of Public Health Sciences, Medical University of South Carolina, Charleston (Q.P., V.L.D.).

3. Department of Emergency Medicine, Temple University, Philadelphia, PA (N.G.).

4. Department of Internal Medicine and Cincinnati VAMC, University of Cincinnati College of Medicine, OH (M.F.).

5. Department of Emergency Medicine, University of Michigan, Ann Arbor (W.M.).

6. Department of Neurology, University of Kentucky, Lexington (C.L.P.).

7. Department of Neurology, Northwestern University, Chicago, IL (T.B.).

8. Department of Neurology, Augusta University, GA (A.B.).

Abstract

Background: Benefit from blood glucose (BG) control during acute ischemic stroke may depend on glycemic parameters. We evaluated for associations between the SHINE (Stroke Hyperglycemia Insulin Network Effort) randomized treatment group and the SHINE predefined 90-day functional outcome, within-patient subgroups defined by various glycemic parameters. Methods: The SHINE Trial randomized 1151 patients within 12 hours with acute ischemic stroke and hyperglycemia to standard (target BG 80–179 mg/dL) or intensive (target BG 80–130 mg/dL) BG control for 72 hours. We predefined 6 glycemic parameters: acute BG level, absence versus presence of diagnosed and undiagnosed diabetes, hemoglobin A1c, glycemic gap (acute BG–average daily hemoglobin A1c based BG), stress hyperglycemia ratio (acute BG/average daily hemoglobin A1c based BG), and BG variability (SD). Favorable functional outcome was defined by the SHINE Trial and based on the modified Rankin Scale score at 90 days, adjusted for stroke severity. We computed relative risks adjusted for baseline stroke severity and thrombolysis use. Results: Likelihood for favorable outcome was lowest among patients with undiagnosed diabetes compared to patients with true nondiabetes (adjusted relative risk, 0.42 [99% CI, 0.19–0.94]). We did not find any relationship between the favorable outcome rate and baseline BG or any of the glycemic parameters. No differences between SHINE treatment groups were identified among any of these patient subgroups. Conclusions: In this exploratory subgroup analysis, intensive versus standard insulin treatment of hyperglycemia in acute ischemic stroke patient subgroups, did not influence the 90-day functional outcomes, nor did we identify associations between these glycemic parameters and 90-day functional outcomes.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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