Insulin for glycaemic control in acute ischaemic stroke

Intravenous insulin, when administered in an attempt to maintain serum glucose within a specific normal range in the first hours of acute ischaemic stroke does not provide benefit in terms of functional outcome, disability, improvement in final neurological deficit, or death at 30 or 90 days, and confers a greater risk of symptomatic and asymptomatic hypoglycaemia.

Summary

A Cochrane review included 11 RCTs with a total of 1583 subjects. In 9 studies participants had a definitive diagnosis of acute ischaemic stroke. Mean age was 74 years. All 11 studies reported intervention with an intravenous insulin infusion. The mean glycaemic level during treatment was significantly lower in the intervention group than in the control group, with a mean difference (MD) of -0.63 (95% CI -0.80 to -0.46). The average glucose level in the intervention group was 6.7 mmol/L, and 7.3 mmol/L in the loose control group.There was no difference between the treatment and control groups in the outcomes of death or dependency (OR 0.99, 95% CI 0.79 to 1.23; 9 trials, n=1516) or final neurological deficit (SMD -0.09, 95% CI -0.19 to 0.01; 8 trials, n=1432). The rate of symptomatic hypoglycaemia was higher in the intervention group (OR 14.6, 95% CI 6.6 to 32.2; 10 trials, n=1455). In the subgroup analyses of diabetes mellitus (DM) versus non-DM, we found no difference for the outcomes of death and disability or neurological deficit. The NNT was not significant for the outcomes of death and final neurological deficit. The NNH was 9 for symptomatic hypoglycaemia.

Ədəbiyyat

1. Bellolio MF, Gilmore RM, Ganti L. Insulin for glycaemic control in acute ischaemic stroke. Cochrane Database Syst Rev 2014;1():CD005346. .