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- Title
Strict Glucose Control After Acute Stroke Can Be Provided in the Prehospital Setting.
- Authors
Nurmi, Jouni; Lindsberg, Perttu J.; Häppölä, Olli; Klemetti, Erkko; Westerbacka, Jukka; Castrén, Maaret
- Abstract
Objectives: The objective was to assess the feasibility of insulin infusion and subcutaneous insulin administered in the prehospital setting and their relative effect on hyperglycemia, a predictor of unfavorable outcome, in acute stroke patients. Methods: Hyperglycemic patients (plasma glucose >6.0 mmol/ L) with stroke symptoms were randomized prior to or during transport to the hospital to receive either 1) a single subcutaneous dose of shortacting insulin (n = 11) or 2) a continuous intravenous (IV) insulin infusion (n = 12) at a rate adjusted by glucose levels measured every 10 minutes and targeted to plasma glucose 4.5-6.0 mmol / L. The changes in plasma glucose concentration were compared with a nonrandomized control group (n = 38) receiving standard care. Results: The baseline characteristics did not differ between the study groups. Plasma glucose concentration was significantly decreased during the prehospital phase in the IV-treated group in comparison to the control group (difference between groups -1.9 mmol / L, 95% confidence interval [CI] = -3.5 to -0.27) with no serious adverse events. In contrast, subcutaneous insulin did not achieve significant lowering of plasma glucose (-0.9 mmol/ L, 95% CI = -2.4 to 0.6). Conclusions: This small sample suggests that adjusted insulin infusion efficiently lowers blood glucose in the ultra-acute phase of stroke and is feasible in the prehospital setting.
- Subjects
FINLAND; BLOOD sugar analysis; ACADEMIC medical centers; SUBCUTANEOUS injections; CEREBROVASCULAR disease; CEREBROVASCULAR disease diagnosis; COMPARATIVE studies; COMPUTER software; CONFIDENCE intervals; DIABETES; PEOPLE with diabetes; EMERGENCY medical services; EMERGENCY medicine; HYPERGLYCEMIA; INFUSION therapy; INSULIN; INTRAVENOUS therapy; LONGITUDINAL method; METABOLIC regulation; HEALTH outcome assessment; PATIENTS; RESEARCH funding; DATA analysis; RANDOMIZED controlled trials; TREATMENT effectiveness; SEVERITY of illness index
- Publication
Academic Emergency Medicine, 2011, Vol 18, Issue 4, p436
- ISSN
1069-6563
- Publication type
Article
- DOI
10.1111/j.1553-2712.2011.01020.x