Glucose control after stroke

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Intensive intravenous glucose control did not improve functional outcome compared with standard insulin control in patients with stroke who have hyperglycaemia— and it may even increase the risk of hypoglycaemia. In the SHINE trial, presented in the International Stroke Conference 2019 by Karen Johnston (University of Virginia, Charlottesville, VA, USA), 581 patients were randomised to receive intensive intravenous insulin treatment (target glucose concentration 80–130 mg/dL) and 570 patients to subcutaneous insulin every 6 h (target glucose concentration 180mg/dl). The trial was stopped for futility when 82% of the planned 1400 patients had been enrolled. 119 (21%) patients in the intensive group and 123 (22%) in the standard group reached the primary endpoint of favourable outcome on the modified Rankin Scale at 90 days, adjusted for baseline severity. The risk of hypoglycaemia was significantly greater in the intensive group (15 events, 2·6%) compared with the standard group (0 events).

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