on October 15, 2009
Published online before print October 15, 2009, doi: 10.1161/STROKEAHA.109.561498
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Submitted on July 6, 2009
From the Departments of Neurology (K.C.J.) and Public Health Sciences (K.C.J., M.R.C.), University of Virginia, Charlottesville, Va; the Department of Neurology and Neurosurgery (C.E.H.), University of Texas South Western, Dallas, Texas; the Department of Neurology (B.M.K.), University of Cincinnati, Cincinnati, Ohio; and the Department of Neurological Sciences, Neurosurgery, and Medicine (T.P.B.), Rush University Medical Center, Chicago, Ill. * To whom correspondence should be addressed. E-mail: Kj4v{at}virginia.edu.
Background and Purpose—Hyperglycemia is associated with worse outcome in patients with acute stroke. Methods—We conducted a prospective, randomized, multicenter, 3-arm trial (tight control [target 70 to 110 mg/dL], loose control [target 70 to 200 mg/dL], and control usual care [70 to 300 mg/dL]) to assess the feasibility and safety of 2 insulin infusion protocol targets in patients with acute ischemic stroke. The planned sample was 72 subjects. Results—A total of 74 subjects were enrolled. Seventy-two (97%) had data available for the primary analyses and 73 (99%) had 3-month clinical outcome data. Median age was 67 years, median National Institutes of Health Stroke Scale score was 8, median glucose was 163 mg/dL, and median time to randomization was 10.7 hours. Fifty-nine percent of patients were diabetic, 35% received thrombolysis, and 14% of subjects died within 3 months. The loose control and usual care groups had median glucose concentrations of 151 mg/dL. The tight control group had a median glucose concentration of 111 mg/dL. The loose control group spent 90% of the first 24 hours in target and the tight group 44% of time in target. There was only one symptomatic patient with hypoglycemia in the loose control group (4%) and zero in the tight control group. The overall rates of hypoglycemia (<55 mg/dL) were 4% in control, 4% in loose, and 30% in tight. Exploratory efficacy analysis was conducted. Conclusions—Insulin infusion for patients with acute ischemic stroke is feasible and safe using the insulin infusion protocol in the Glucose Regulation in Acute Stroke Patients (GRASP) trial. Exploratory efficacy analysis supports further comparative study.
Revised on August 14, 2009
Accepted on August 17, 2009
Glucose Regulation in Acute Stroke Patients (GRASP) Trial. A Randomized Pilot Trial
Karen C. Johnston MD, MSc*;
Key words: clinical trial • glucose • stroke