Abstract WMP75: Is Glycemic Control With Sliding Scale Insulin Therapy Safe For Diabetic Patients With Acute Ischemic Stroke?
Backgroundand Purpose: There is no established glycemic control for acute ischemic stroke. Patients’ outcomes may be deteriorated by strict glycemic control with sliding-scale insulin therapy (SSIT) via hypoglycemia. We aimed to investigate baseline characteristics, frequency of hypoglycemia and outcome in diabetic patients who received SSIT in acute ischemic stroke.
Methods: Consecutive ischemic stroke patients with diabetes mellitus (DM) admitted to our hospital within 7 days of onset from 2008 through 2010 were studied. DM was defined as having prior diabetic medications, fasting plasma glucose (PG) of 126mg/dl, 2-h PG of ≥200 mg/dl during a 75g OGTT, random PG of ≥200 mg/dl, or HbA1c (NGSP) of ≥6.5%. Physicians in charge decided whether the patient was treated with sliding scale insulin therapy (SSIT) at admission. Hypoglycemia was defined as having PG of ≤80 mg/dl during hospitalization. Favorable outcome was defined as mRS 0-1 at 3 months.
Results: Of a total 258 ischemic stroke patients with DM (193 men, 72 ± 10 yo), 130 (96 men, 71±10 yo) received SSIT (SSIT group) and the remaining 128 (97 men, 73±9 yo) did not (N group). Patients in the SSIT group more frequently took prior diabetic medication (72% vs 53%, p=0.001), had higher initial PG (199±85 mg/dl vs 156±78 mg/dl, p<0.001), higher HbA1c (7.8±1.9% vs 6.8±1.2%, p<0.001) and higher initial NIHSS [median 4 (IQR 2-7) vs. 3 (IQR 1-5), p=0.028] than those in the N group. Hypoglycemia tended to be more common (15% vs 7%, p=0.050) and favorable outcome tended to be less common (43% vs 54%, p=0.081) in the SSIT group than in the N group. In the SSIT group, 19 patients showing hypoglycemia were older (76±8 years vs 71±10 years, p=0.031), more frequently took prior diabetic medication (95% vs 68%, p=0.015), and had lower admission levels of PG (163±68 mg/dl vs 206±86 mg/dl, p=0.040) and HbA1c (6.9±1.3% vs 7.9±2.0%, p=0.035) than those in the remaining 111 patients without hypoglycemia.
Conclusions: Acute ischemic stroke patients with prior diabetic medication, poor glycemic control before onset and severer stroke symptom often received SSIT. Hypoglycemia was found in one seventh of patients treated with SSIT. We have to be careful especially when aged patients or diabetic medication users receive SSIT.
- © 2012 by American Heart Association, Inc.