Impact of Tight Glycemic Control on Short Term Outcome of Patients with Acute Cerebral Ischemia

Abstract

Abstract Background Hyperglycemia is common after acute ischemic stroke and is associated with poor outcomes, including increased in-hospital mortality and poor neurologic function. Various mechanisms for the detrimental effects of hyperglycemia after acute ischemic stroke have been proposed, but a lack of consensus on the pathophysiology of hyperglycemia-aggravated secondary brain injury remains. Objective To evaluate the impact of tight glycemic control on short term outcome of patients with acute cerebral ischemic stroke. Methods This was a randomized control trial that was conducted at neurological intensive care unit, Ain Shams University Hospitals on 66 patients presenting with acute cerebral ischemia within 12 hours of acute symptoms and admitted to the Casualty. Patients were categorized into two groups: Group (A): the control group (33), with normal glycemic control using insulin infusion on sliding scale. Group (B): the study group (33) that included patients subjected to tight glycemic using insulin infusion on sliding scale. Results Our study revealed that, in Group A; 9.1% died, while the Group B; 12.1% of them died with no statistically significant difference between Group A and Group B regarding Death. Conclusion Insulin may be the gold standard for the management of hyperglycaemia but tight glycaemic control appears to be ineffective in improving outcomes in patients with acute cerebral ischemic stroke compared to normal glycaemic control. And it increases the incidence of hypoglycemia and hypokalaemia. Thus tight glycaemic control is not recommended in acute ischemic stroke.