Intensive Glucose Management Poststroke Does Not Improve Outcomes and May Increase Risks

Results of the SHINE study (NCT01369069) presented at a plenary during the International Stroke Conference in Honolulu, HI show that intensive management of hyperglycemia for 72 hours did not improve functional outcomes for patients after acute ischemic stroke (AIS) (n = 584; = .55)) compared to standard glucose therapy (n = 570). Functional outcomes were measured with the modified Rankin Scale (mRS) score at 90 days. Intense glucose therapy for the treatment of hyperglycemia in patients after AIS also increase the risk of hypoglycemia and required a higher level of care, including increased supervision from nursing staff. 

In this study, a multisite randomized controlled clinical trial of 1,151 patients are being randomly assigned within 12 hours of stroke symptom onset to receive intensive glucose control or standard glucose control. To be enrolled, patients must have type II diabetes and a glucose level more than 110 mg per dL or no history of diabetes and glucose levels above 150 mg per dL. For this study, intensive glucose control is defined as the use of intravenously delivered insulin to achieve a target level of 80 to 130 mg per dL blood glucose; standard glucose control is defined as using subcutaneous insulin injections to achieve a target level of less than 180 mg per dL blood glucose. 

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Amyotrophic Lateral Sclerosis

Jonathan R. Brent, MD, PhD; and Senda Ajroud-Driss, MD