Study examines blood sugar levels and stroke patient recovery

MGN
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CHARLOTTESVILLE, Va. (CBS19 NEWS) -- A multi-site clinical study being led by the University of Virginia is helping understand ways to control blood sugar levels in stroke patients.

According to a release, hyperglycemia, or high levels of glucose in the blood, is a common problem in patients with acute ischemic stroke and it is associated with worse outcomes compared to normal blood sugar levels.

It adds animal studies have also pointed to an effect of high blood sugar in worsening stroke injury.

The question has been whether or not intensive glucose management after acute ischemic stroke would lead to a better outcome.

This new study, which was published in the journal JAMA, found aggressive methods are not better than standard approaches.

"After decades of uncertainty about how to manage blood sugar in acute stroke patients, we finally have strong clinical evidence that aggressive lowering does not improve patient outcome," said Walter Koroshetz, MD, the director of the National Institute of Neurological Disorders and Stroke, a part of the National Institutes of Health which supported this study.

The release says the Stroke Hyperglycemia Insulin Network Effort, or SHINE, study is a large, multi-site clinical study being led by Karen C. Johnston, MD, a professor of neurology and associated vice president of clinical and translational research at UVA.

Two commonly used strategies for glucose control in ischemic stroke were compared, with more than 1,100 patients undergoing intensive glucose management requiring the use of intravenous delivery insulin or standard glucose control using insulin shots.

After 90 days, the patients were evaluated for their outcomes, including information on disability, neurological function and their quality of life.

The release explains the results suggest the two treatments were equally effective, with about 20 percent showing favorable outcomes regardless of if they were given the intensive or standard treatment.

It adds the study was stopped early when an interim analysis found there were no improved outcomes with the intensive glucose control treatment, which also required a higher level of care with increased supervision and a risk of hypoglycemia, or very low blood glucose levels.

"We found that the extra risks associated with aggressive treatment were not worth it," said Johnston. "We are so grateful to the patients and research teams from across the country who helped us answer this important question. As a result of their participation, patients around the world will benefit."

However, the release says more research is needed to better understand the role of blood glucose in stroke recovery and to help identify treatments that may improve outcomes in hyperglycemic stroke patients.

Future studies will also be needed to see if high blood sugar is a cause or effect of unfavorable stroke outcomes.

This study was supported by NINDS' Neurological Emergencies Treatment Trials Network, a system of research institutions dedicated to emergency medical issues, such as stroke.

It was also conducted in collaboration with StrokeNet, a network of hospitals that provide resources for multi-site clinical trials that are evaluating new therapies to treat stroke.



 
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