Glycemia in Acute Stroke II study: a call to improve post-stroke hyperglycemia management in clinical practice

Background and purposeThe aim of the study was to analyze the effect of conventional glucose management, which aimed to maintain glucose levels <155mg/dL (8.5mmol/L), on glucose control and the outcomes of patients with acute ischaemic stroke (IS) in a clinical practice setting. MethodsThis was a multicenter, prospective cohort study of patients with acute IS. Patients were classified into four groups based on their initial 48-h capillary glucose levels and the administration of and response to corrective treatment: (i) untreated and maximum glucose levels <155mg/dL (8.5mmol/L) within the first 48h; (ii) treated and good responders [glucose levels persistently <155mg/dL (8.5mmol/L)]; (iii) treated and non-responders [any glucose values 155mg/dL (8.5mmol/L) during the 24h after the start of corrective treatment]; and (iv) untreated with any glucose value 155mg/dL (8.5mmol/L). The primary outcome was death or dependence at 3months (blinded rater). ResultsA total of 213 patients were included. Ninety-seven (45.5%) patients developed glucose levels 155mg/dL (8.5mmol/L), 69 (71.1%) underwent corrective treatment and 31 patients underwent no corrective treatment at the physician's discretion [28 of whom had isolated values 155mg/dL (8.5mmol/L)]. Only 11 (16%) patients responded to conventional treatment, whereas 58 (84%) patients were non-responsive. Non-responders showed a twofold higher risk of death or dependence at 3months (odds ratio, 2.472; 95% confidence interval, 1.096-5.576; P=0.029). ConclusionsLack of response to conventional treatment for glucose management in acute IS is frequent and associated with poor outcomes. Click for the corresponding questions to this CME article.