Intensive Versus Standard Glucose Control in Patients with Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials

Abstract

Hyperglycemia is common in patients with ischemic stroke (IS) and has been proven to be associated with worse clinical outcomes. However, it is controversial whether intensive glucose control (IGC) is superior to standard glucose control (SGC). Therefore, we carried out this meta-analysis based on randomized controlled trials (RCTs). We systematically searched databases for RCTs that evaluated the efficacy of IGC versus SGC in patients with IS. The retrieval time was limited from the establishment of the database to October 2019. The retrieval databases included PubMed, Medline, Embase, OVID, Web of Science, Google Scholar, and a Chinese literature database. Two researchers independently screened and evaluated the quality of literature. We used Stata 11.0 software for data analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to compare the results. Finally, 7 RCTs including 1691 participants were included in this study. Among the patients, 857 patients were in the IGC group and 834 were in the SGC group. Our results show that IGC significantly increased the risk of hypoglycemia compared with SGC (OR, 4.76; 95% CI, 1.17-19.45). No significant differences were observed in modified Rankin scale score ≤2 (OR, 0.97; 95% CI, 0.75-1.25), National Institutes of Health Stroke Scale score ≤2(OR, 1.48; 95% CI, 0.54-4.06), and death (OR, 0.74; 95% CI, 0.53-1.02) between the 2 groups within 3 months. Our results suggest there is no evidence that IGC is superior to SGC in patients with IS, but IGC increases the risk of hypoglycemia.