Poststroke hyperglycemia - Natural history and immediate management

Background and Purpose-Poststroke hyperglycemia (PSH) is a frequent finding for which there is currently no evidence to justify routine treatment. The United Kingdom Glucose Insulin in Stroke Trial (GIST-UK) is the only trial of glucose modulation in acute stroke from which evidence can be derived for the immediate management of PSH. Using safety-monitoring data from the trial we aimed to describe the immediate recovery of PSH in treated and control patients, thus providing evidence for the use of glucose/potassium/ insulin (GKI) infusions as a means of maintaining euglycemia. Methods-GIST-UK is a multicenter randomized controlled trial of GKI or saline infusions in acute stroke patients presenting with mild to moderate hyperglycemia (admission plasma glucose, 6.0 to 17 mmol). We analyzed the capillary BM and plasma glucose values in the 2 treatment groups to describe the recovery of PSH and the effectiveness of the GIST treatment regimen in maintaining euglycemia. Results-The majority of patients have only moderate PSH (mean plasma glucose, 8.37+/-SD 2.13). Without specific intervention, mean plasma glucose levels decline spontaneously. Treatment with the GIST GKI regimen rapidly achieved euglycemia at significantly lower levels than with saline hydration alone. Euglycemia was achieved with a median of 2 changes to the GKI regimen and a low risk of hypoglycemia. Conclusions-GKI infusions as described in the GIST trial are a safe and effective means of correcting PSH and maintaining euglycemia in the acute phase of stroke. The clinical benefits of routine management of hyperglycemia remain to be determined.