Insulin for glycaemic control in acute ischaemic stroke

Area of Science:

• Neurology
• Endocrinology
• Critical Care Medicine

Background:

• Hyperglycemia in acute stroke patients is linked to worse outcomes, including higher mortality and functional impairment.
• This review is an update of a previous Cochrane Review first published in 2011.

Purpose of the Study:

• To evaluate the impact of intensive insulin therapy on outcomes in patients with acute ischemic stroke.
• The study aimed to determine if maintaining serum glucose within a specific range (4-7.5 mmol/L) in the first 24 hours improves patient outcomes.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
• Eleven RCTs involving 1583 participants were included, comparing intensive insulin therapy with usual care.
• Data on mortality, dependency, and neurological deficit were extracted and analyzed.

Main Results:

• Intensive insulin therapy showed no significant difference in reducing death or dependency (OR 0.99, 95% CI 0.79 to 1.23).
• There was no significant difference in final neurological deficit between groups (SMD -0.09, 95% CI -0.19 to 0.01).
• The rate of symptomatic hypoglycemia was significantly higher in the intensive insulin group (OR 14.6, 95% CI 6.6 to 32.2), with a number needed to harm of nine.

Conclusions:

• Intensive insulin therapy in the initial hours of acute ischemic stroke does not improve functional outcomes or reduce mortality.
• This treatment strategy significantly increases the risk of symptomatic and asymptomatic hypoglycemia.
• The findings suggest that tight glucose control with intravenous insulin in acute ischemic stroke is not beneficial and carries increased risks.