Abstract
This pilot, randomized, open-label controlled study compared the basal–bolus regimens of insulin glargine (IG) and neutral protamine Hagedorn (NPH) insulin in stroke patients with hyperglycemia receiving intensive care. The study recruited acute stroke patients requiring intensive care within 72 h (h) of onset and had blood glucose > 200 mg/dL. 50 patients received IG (n = 26) or NPH (n = 24) with added short-acting prandial regular insulin over a 72-h period. The primary end point was the percentage of glucose within 80–180 mg/dL assessed through continuous glucose monitoring. The baseline characteristics were comparable, except the IG had higher glucose pre-randomization than the NPH (290.69 ± 82.31 vs. 246.04 ± 41.76 mg/dL, P = 0.021). The percentage of time with glucose between 80 and 180 mg/dL was 45.88 ± 27.04% in the IG and 53.56 ± 22.89% in the NPH (P = 0.341) and the percentage of glucose reduction was 31.47 ± 17.52% in the IG and 27.28 ± 14.56% in the NPH (P = 0.374). The percentage of time with glucose < 60 mg/dL was 0.14 ± 0.49% in the IG and 0.47 ± 1.74% in the NPH. Poststroke outcomes were not significantly different. In conclusion, IG is safe and equally effective as an NPH-based basal-bolus regimen for acute stroke patients with hyperglycemia receiving intensive care.Trial registration ClinicalTrials.gov, NCT02607943. Registered 18/11/2015, https://clinicaltrials.gov/ct2/show/NCT02607943.
Highlights
This pilot, randomized, open-label controlled study compared the basal–bolus regimens of insulin glargine (IG) and neutral protamine Hagedorn (NPH) insulin in stroke patients with hyperglycemia receiving intensive care
The Guidelines for the Early Management of Patients with Acute Ischemic Stroke from the American Heart Association and the American Stroke Association suggest that the blood glucose level should be maintained between 140 and 180 mg/dL, in accordance with the current American Diabetes Association recommendation[9, 10]
The objective of this randomized controlled study was to determine the efficacy and safety of early initiation of subcutaneous once-daily IG compared with standard NPH regimens to achieve proper glycemic control in patients with acute stroke and hyperglycemia admitted to the intensive care unit (ICU)
Summary
This pilot, randomized, open-label controlled study compared the basal–bolus regimens of insulin glargine (IG) and neutral protamine Hagedorn (NPH) insulin in stroke patients with hyperglycemia receiving intensive care. A recent trial suggested that for patients with acute ischemic stroke and hyperglycemia, aggressive intravenous insulin infusion has a significantly higher chance of inducing hypoglycemia without absolute clinical benefits compared with subcutaneous insulin injection[12]. Evidence regarding the use of IG in patients with acute stroke and hyperglycemia is limited The objective of this randomized controlled study was to determine the efficacy and safety of early initiation of subcutaneous once-daily IG compared with standard NPH regimens to achieve proper glycemic control in patients with acute stroke and hyperglycemia admitted to the intensive care unit (ICU)
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