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Updated: May 29, 2026
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Insulin for glycaemic control in acute ischaemic stroke
M Fernanda Bellolio1, Rachel M Gilmore, Latha G Stead
1Department of Emergency Medicine, Mayo Clinic, Genrose Building-G410, 200 First Street SW, Rochester, Minnesota, USA, 55905.
The Cochrane Database of Systematic Reviews
|September 9, 2011
Summary
Intensive insulin therapy for acute ischemic stroke does not improve outcomes and increases hypoglycemia risk. Maintaining normal blood glucose levels in the first 24 hours showed no benefit for stroke severity or functional impairment.
Area of Science:
- Neurology
- Endocrinology
- Clinical Trials
Background:
- Hyperglycemia in acute stroke patients correlates with increased stroke severity and functional impairment.
- Normoglycemia at stroke presentation is associated with better outcomes.
Purpose of the Study:
- To evaluate if maintaining serum glucose between 4 to 7.5 mmol/L in the first 24 hours of acute ischemic stroke impacts patient outcomes.
- To assess the efficacy and safety of intensive insulin therapy in acute ischemic stroke.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials.
- Searched multiple databases including Cochrane, MEDLINE, EMBASE, and Web of Science up to June 2010.
- Included seven trials with 1296 participants comparing intensive insulin therapy to usual care.
Main Results:
- No significant difference was found in death or disability (OR 1.00, 95% CI 0.78 to 1.28) or final neurological deficit (SMD -0.12, 95% CI -0.23 to 0.00) between groups.
- The intervention group experienced a significantly higher rate of symptomatic hypoglycemia (OR 25.9, 95% CI 9.2 to 72.7).
- Subgroup analysis for patients with and without diabetes mellitus showed no difference in outcomes.
Conclusions:
- Intravenous insulin therapy aimed at tight glycemic control in acute ischemic stroke does not improve functional outcomes or reduce mortality.
- Intensive glucose management significantly increases the risk of hypoglycemic episodes, both symptomatic and asymptomatic.
- Current evidence does not support the use of intensive insulin therapy for improving outcomes in acute ischemic stroke.
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