Hyperglycemia Treatment with Intravenous Insulin in Acute Stroke Patients: A Scoping Review

Abstract

Introduction/Background: Hyperglycemia has been shown to lead to worse outcomes for ischemic stroke patients, including those undergoing reperfusion therapies. However current guidelines do not exclude hyperglycemic patients from reperfusion therapy. This scoping review examines what is known about the safety, feasibility, and efficacy of intravenous insulin treatment for hyperacute and acute ischemic stroke patients. Methods: PubMed, EBSCOhost, the Cochrane Database of Systemic Reviews, Embase, and Google Scholar were searched from inception to March 25, 2024. Titles, abstracts, and full texts were reviewed. Studies qualified for inclusion if they were peer-reviewed, published in English, full-text, human experimental studies using intravenous insulin for hyperglycemia treatment for hyperacute or acute stroke patients reviewing serious adverse events, feasibility, disability, or functional outcomes. Results: Ten studies were included (n=6 safety/feasibility design, n=4 efficacy design). Intravenous insulin infusion treatment targets ranged from 72-144 mg/dL, comprising of both loose and tight target controls, with symptom onset to treatment max times of 6-24 hours. Conclusions: There are limited clinical trials evaluating IV insulin for the ischemic stroke population. Of the studies found, hyperglycemia treatment with regular or GKI intravenous insulin in acute stroke patients suggest that with tight or loose control, is a safe and feasible option for at least 72 hours after symptom onset. However, it has not been demonstrated that hyperglycemia treatment alters outcomes when initiated within 6-24 hours of symptom onset.