A prospective, observational study of the management of hyperglycaemia in acute stroke. What is the optimum level of blood glucose at which to intervene?

Grant, Paul S and Ali, Khalid (2010) A prospective, observational study of the management of hyperglycaemia in acute stroke. What is the optimum level of blood glucose at which to intervene? British Journal of Diabetes and Vascular Disease, 10 (6). pp. 287-291. ISSN 1474-6514

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Abstract

Background
It is well known that blood glucose levels are increased in the first 12 hours after the onset of acute stroke. The magnitude of the rise is supposedly related to the severity of the stroke and this is in turn associated with a worse prognosis. Several guidelines advocate the use of insulin sliding scales in the acute stroke setting but these are only implemented with varying degrees of success. There is no clear evidence base as to the glycaemic level at which to intervene and the significance of the intervention on outcomes.

Methods
We prospectively reviewed the treatment of 229 patients admitted to a stroke unit and compared admission blood glucose results with stroke prognostic/neurological deficit score (National Institutes of Health Stroke Scale) at 30 days. Inter-physician practice variability allowed us to observe the outcomes when different levels for intervention were used (and allowed us to calculate an optimum level of glucose at which insulin sliding scale treatment would lead to most benefit).

Results
We showed that glucose is a modifiable factor that has implications for long-term stroke outcomes.

Conclusion
The suggested level for intervention with insulin (admission blood glucose of ≥ 10.1 mmol/L) is lower than previously thought.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Primary Care and Public Health
Subjects: R Medicine > RC Internal medicine > RC0581 Specialties of internal medicine > RC0952 Geriatrics
Depositing User: Simone Breckell
Date Deposited: 13 May 2013 12:35
Last Modified: 13 May 2013 12:35
URI: http://sro.sussex.ac.uk/id/eprint/44693
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