Influence of glycaemic control on the outcomes of patients treated by intravenous thrombolysis for cerebral ischaemia

J Neurol. 2015 Nov;262(11):2504-12. doi: 10.1007/s00415-015-7874-5. Epub 2015 Aug 15.

Abstract

Whether the glycaemic control during the first hours of cerebral ischaemia treated by thrombolysis influences outcomes remains unsettled. We aimed at evaluating the quality of the glycaemic control and whether patients with well-controlled glycaemia after thrombolysis for acute cerebral ischaemia have better outcomes. We retrospectively analysed data prospectively collected in consecutive stroke patients who received i.v. thrombolysis at the Lille University Hospital. Patients with glycaemia >1.6 g/l (8.9 mmol/l) at any point during the first 48 h received insulin. We used 2 definitions of well controlled glycaemia: (i) "well controlled 100 %" when 100 % glycaemia were <1.6 g/l (8.9 mmol/l), and (ii) "well controlled 70 %" when at least 70 % glycaemia were <1.6 g/l (8.9 mmol/l). The outcome measures at 3 months were (1) independence [modified Rankin scale (mRS) score 0 or 1], (2) absence of handicap (mRS 0-2), (3) death, and (4) symptomatic intracerebral haemorrhage (sICH). Of 875 consecutive patients, 657 (75.2 %) were considered as well controlled with a threshold at 100 % and 736 (84.2 %) with a threshold at 70 %. The glycaemic control was not independently associated with any of the four outcome measures. In patients treated by insulin, hypoglycaemic events were rare (2.1 % of all patients) and of moderate intensity [>0.5 g/l (2.8 mmol/l)]. The quality of the glycaemic control was not associated with outcomes in patients treated by thrombolysis. A possible explanation is that the glycaemic control after thrombolysis has minor influence compared with glycaemic control before thrombolysis when the artery is not yet re-open and the penumbra area at maximum.

Keywords: Cerebral haemorrhage; Cerebral ischaemia; Diabetes mellitus; Glycaemic control; Ischaemic stroke; Outcome; Serum glucose level; Symptomatic haemorrhagic transformation; Thrombolysis.

MeSH terms

  • Administration, Intravenous
  • Aged
  • Aged, 80 and over
  • Blood Glucose / analysis
  • Blood Glucose / drug effects
  • Brain Ischemia* / blood
  • Brain Ischemia* / drug therapy
  • Brain Ischemia* / epidemiology
  • Comorbidity
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / pharmacology*
  • Follow-Up Studies
  • Glucose Metabolism Disorders* / blood
  • Glucose Metabolism Disorders* / drug therapy
  • Glucose Metabolism Disorders* / epidemiology
  • Humans
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / pharmacology*
  • Insulin / administration & dosage
  • Insulin / pharmacology*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Retrospective Studies
  • Tissue Plasminogen Activator / administration & dosage
  • Tissue Plasminogen Activator / pharmacology*

Substances

  • Blood Glucose
  • Fibrinolytic Agents
  • Hypoglycemic Agents
  • Insulin
  • Tissue Plasminogen Activator