OBJECTIVES: The objective was to assess the feasibility of insulin infusion and subcutaneous insulin administered in the prehospital setting and their relative effect on hyperglycemia, a predictor of unfavorable outcome, in acute stroke patients. METHODS:Hyperglycemic patients (plasma glucose >6.0 mmol/L) with stroke symptoms were randomized prior to or during transport to the hospital to receive either 1) a single subcutaneous dose of short-acting insulin (n = 11) or 2) a continuous intravenous (IV) insulin infusion (n = 12) at a rate adjusted by glucose levels measured every 10 minutes and targeted to plasma glucose 4.5-6.0 mmol/L. The changes in plasma glucose concentration were compared with a nonrandomized control group (n = 38) receiving standard care. RESULTS: The baseline characteristics did not differ between the study groups. Plasma glucose concentration was significantly decreased during the prehospital phase in the IV-treated group in comparison to the control group (difference between groups -1.9 mmol/L, 95% confidence interval [CI] = -3.5 to -0.27) with no serious adverse events. In contrast, subcutaneous insulin did not achieve significant lowering of plasma glucose (-0.9 mmol/L, 95% CI = -2.4 to 0.6). CONCLUSIONS: This small sample suggests that adjusted insulin infusion efficiently lowers blood glucose in the ultra-acute phase of stroke and is feasible in the prehospital setting.
RCT Entities:
OBJECTIVES: The objective was to assess the feasibility of insulin infusion and subcutaneous insulin administered in the prehospital setting and their relative effect on hyperglycemia, a predictor of unfavorable outcome, in acute strokepatients. METHODS: Hyperglycemic patients (plasma glucose >6.0 mmol/L) with stroke symptoms were randomized prior to or during transport to the hospital to receive either 1) a single subcutaneous dose of short-acting insulin (n = 11) or 2) a continuous intravenous (IV) insulin infusion (n = 12) at a rate adjusted by glucose levels measured every 10 minutes and targeted to plasma glucose 4.5-6.0 mmol/L. The changes in plasma glucose concentration were compared with a nonrandomized control group (n = 38) receiving standard care. RESULTS: The baseline characteristics did not differ between the study groups. Plasma glucose concentration was significantly decreased during the prehospital phase in the IV-treated group in comparison to the control group (difference between groups -1.9 mmol/L, 95% confidence interval [CI] = -3.5 to -0.27) with no serious adverse events. In contrast, subcutaneous insulin did not achieve significant lowering of plasma glucose (-0.9 mmol/L, 95% CI = -2.4 to 0.6). CONCLUSIONS: This small sample suggests that adjusted insulin infusion efficiently lowers blood glucose in the ultra-acute phase of stroke and is feasible in the prehospital setting.
Authors: Dae-Hyun Kim; Jeffrey L Saver; Sidney Starkman; David S Liebeskind; Latisha K Ali; Lucas Restrepo; May Kim-Tenser; Miguel Valdes-Sueiras; Marc Eckstein; Frank Pratt; Samuel Stratton; Scott Hamilton; Robin Conwit; Nerses Sanossian Journal: Stroke Date: 2015-12-10 Impact factor: 7.914
Authors: Polly Scutt; Jason P Appleton; Mark Dixon; Lisa J Woodhouse; Nikola Sprigg; Joanna M Wardlaw; Alan A Montgomery; Stuart Pocock; Philip M Bath Journal: Eur Stroke J Date: 2018-02-01
Authors: Hanna Vihonen; Ilkka Tierala; Markku Kuisma; Jyrki Puolakka; Jukka Westerbacka; Jouni Nurmi Journal: Scand J Trauma Resusc Emerg Med Date: 2014-05-01 Impact factor: 2.953