#VisualAbstract: Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients With Acute Ischemic Stroke

1. In this randomized controlled trial, intensive hyperglycemia treatment did not lead to improved outcomes compared to standard treatment in patients 90 days after stroke.

2. The intensive therapy group experienced more episodes of hypoglycemia and more adverse events attributed to hypoglycemia.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Hyperglycemia is common in acute ischemic stroke and is associated with worse clinical outcomes, including greater infarct growth and hemorrhagic infarct conversion. However, it is unclear if more intense hyperglycemia management would prevent these sequelae and improve outcomes. In this randomized controlled trial, intensive compared with standard glucose control did not improve 90-day functional outcomes in patients with acute ischemic stroke and hyperglycemia. The intensive therapy group had more episodes of hypoglycemia and more adverse events attributed to hypoglycemia.

This study has several limitations. First, almost half of the patients were enrolled by only six of the clinical sites, and site-specific practices may reduce the generalizability of the results. Second, treatment with intravenous tissue plasminogen activator therapy in 63% of the patients may suggest a selection bias for patients requiring a higher level of care. Third, this trial did not capture recanalization data.

Click to read the study in JAMA