Researchers get a handle on how to control blood sugar after stroke

Hyperglycemia, or high levels of glucose, is common in patients with acute ischemic stroke and is associated with worse outcomes compared to normal blood sugar levels. Animal studies also pointed to an effect of high blood sugar in worsening stroke injury. Stroke experts have debated whether intensive glucose management after acute ischemic stroke leads to better outcomes but a new study in JAMA finds that aggressive methods are not better than standard approaches.

Researchers get a handle on how to control blood sugar after stroke. Photo: NIH

“After decades of uncertainty about how to manage blood sugar in acute stroke patients we finally have strong clinical evidence that aggressive lowering does not improve patient outcome,” said Walter Koroshetz, M.D., National Institute of Neurological Disorders and Stroke (NINDS) director.

The Stroke Hyperglycemia Insulin Network Effort (SHINE) study, a large, multisite clinical study, compared two commonly used strategies for glucose control in ischemic stroke patients. More than 1100 patients underwent intensive glucose management, which required the use of intravenous delivery of insulin to bring blood sugar levels down to 80-130 mg/dL, or standard glucose control using insulin shots, which aimed to get glucose below 180 mg/dL, for up to 72 hours. After 90 days, the patients were evaluated for outcomes, including disability, neurological function, and quality of life.

The results suggested that the two treatments were equally effective at helping the patients recover from their strokes. After 90 days, about 20% of the patients showed favorable outcomes regardless of whether they were given intensive or standard treatment.

Intense glucose therapy increased the risk of very low blood glucose (hypoglycemia) and required a higher level of care such as increased supervision from nursing staff, compared to standard treatment.

The study was stopped early when a pre-planned interim analysis revealed that intensive glucose control did not improve outcomes compared to standard treatment.

More research is needed to better understand the role of glucose in stroke recovery and to identify additional treatments to improve outcomes in hyperglycemic stroke patients. Future studies will also determine whether high blood sugar is a cause or effect of unfavorable stroke outcomes. (National Institutes of Health)

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