Findings may have immediate impact on clinical practice

What

Hyperglycemia, or increased glucose, is common in patients with acute ischemic stroke and is associated with worse outcomes compared to normal glucose levels. Doctors all over the world have debated whether intensive glucose management—which requires the use of intravenous (IV) insulin to bring blood sugar levels down to 80–130 mg/dL—or standard glucose control using insulin shots—which aims to get glucose below 180 mg/dL—lead to better outcomes after stroke. Primary results from the Stroke Hyperglycemia Insulin Network Effort (SHINE) study, a large, multisite clinical study provide a clear answer to that question.

The primary results show that intensive glucose management did not improve functional outcomes at 90 days after stroke compared to standard glucose therapy. In addition, intense glucose therapy increased the risk of very low blood glucose (hypoglycemia) and required a higher level of care, such as increased supervision from nursing staff, compared to standard treatment.

Who

Walter Koroshetz, MD, director of the National Institutes of Health's (NIH's) National Institute of Neurological Disorders and Stroke (NINDS), and Clinton Wright, MD, director of clinical research at NINDS, are available to comment on this study. To arrange interviews, please contact nindspressteam@ninds.nih.gov

Presentation

Johnston, et al. “The SHINE Trial: Intensive versus Standard Treatment of Hyperglycemia in Acute Ischemic Stroke,” February 6, 2019, International Stroke Conference.