Management of Diabetes and Hyperglycaemia following Stroke

There is still no safe, simple and effective medical therapy for the majority of acute stroke patients. Although thrombolysis with rt-PA when given within 3 h of symptom onset following ischaemic stroke has been shown to improve functional recovery, there remains concern regarding the risk/benefit of such treatment. Routine use of thrombolysis for stroke in the UK is minimal and even in experienced North American centres less than 20% of potentially eligible patients receive such therapy (Johnston etal., 2000b).

Apart from thrombolysis, recent advances in acute stroke treatments have been consistently disappointing (neuroprotective therapy) and attention is once again being directed towards monitoring and modifying physiological variables that may influence stroke outcome. In the absence of a simple and effective medical therapy there is increasing evidence that the provision of specialist stroke care within acute and rehabilitation stroke units is associated with improved outcome (Stroke Unit Trialists' Collaboration, 1997). Such evidence has led to the widespread introduction of stroke units. An essential component of acute stroke unit care is the intensive monitoring of physiological variables (hydration, glucose, temperature, blood pressure, oxygen saturation) and their early correction. It remains to be determined, however, whether such intervention does actually improve patient outcomes.

The Royal College of Physicians (UK) National Clinical Guidelines for Stroke highlight the importance of organised stroke care and the need to consider the early management of hyperglycaemia, blood pressure, hydration and pyrexia (Intercollegiate Working Party for Stroke, 2000). Whilst there is accumulating evidence for a link between hyperglycaemia, diabetes and enhanced ischaemic cerebral damage, such an association has never been confirmed by any clinical trial. Similarly, any potential insulin treatment effect has not been examined in appropriate clinical trials.

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