Strict Glucose Control After Acute Stroke Can Be Provided in the Prehospital Setting

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Abstract:

ACADEMIC EMERGENCY MEDICINE 2011; 18:436–439 © 2011 by the Society for Academic Emergency Medicine Abstract 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.

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1553-2712.2011.01020.x

Publication date: April 1, 2011

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