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glycaemic control (2 posts to May 2023)
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Safety and Efficacy of Tight Versus Loose Glycemic Control in Acute Stroke Patients: A Meta-Analysis of Randomized Controlled Trials
Abstract
Background:
Hyperglycemia
is associated with worse stroke outcomes but it is uncertain whether
tight glycaemic control during the acute stroke period is associated
with a better outcome. We conducted a meta-analysis to compare the
effect of tight glycemic control versus loose glycemic control in the
acute phase of stroke patients.
Methods:
A
literature search was performed to identify randomized controlled
trials (RCTs) comparing the safety and efficacy of tight glycemic
control with a relatively loose control of blood glucose of acute stroke
(ischemic or hemorrhagic) patients within 24 hours after stroke onset.
We required that the blood glucose level of the patients should not be
lower than 6.11mmol/L at the time of enrollment, and for the intensive
blood glucose control range, we defined the blood glucose level as lower
than that of the control group.Tight glycaemic control was defined as
blood glucose ≥ 6.11 mmol/L. The primary efficacy outcome measure was
deaths from any cause at 90 days. Secondary efficacy outcomes comprised
the number of participants with modified Rankin score (mRS), We define
mRS scores 0-2 as favorable scores, recurrent stroke, and the National
Institute of Health stroke scale (NIHSS) or the European Stroke Scale
(ESS) scores. We defined the number of participants with hypoglycemia as
our primary safety outcome. Subgroup analysis was performed according
to age, the variety of interventions, maintained glucose level, and
status of hypoglycemia on NIHSS scores or ESS scores.
Results:
Fifteen
RCTs with 2957 participants meeting the including criteria were
identified and included in this meta-analysis, although not all included
data on every outcome measure. Data on the primary efficacy endpoint,
mortality at 90 days, was available in 11 RCTs a total of 2575
participants. There was no significant difference between the
intervention and control groups (OR: 1.00; 95%CI: 0.81 to 1.23; P=0.99).
For secondary endpoints, there was no difference between intervention
and control groups for a mRS < from 0-2 (OR: 0.96; 95%CI: 0.80 to
1.15; P=0.69; data from 9 RCTs available), or recurrent stroke (OR:
1.34; 95%CI: 0.92 to 1.96; P=0.13; data from 3 RCTs available). For
NIHSS scores or ESS scores, there was a small difference in favor of
intensive controls (SMD: -0.29; 95%CI: -0.54 to -0.04; P=0.02) There was
a marked increase in hypoglycemia with tight control: (OR of 9.46
(95%CI: 4.59 to 19.50; P<0.00001; data from 9 RCTs available)
Conclusions:
There
was no difference between tight and loose glycemic control on
mortality, independence, or recurrent stroke outcome in acute stroke,
but an increase in hypoglycaemia. There was a small effect improvement
on neurological scales but the relevance of this needs confirming in
future adequately powered studies.
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