June 2009, Volume 11, Issue 3, pp 201-211
Date: 02 May 2009
Optimum control of blood glucose for prevention and treatment of ischemic and hemorrhagic stroke
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Stroke is the most common cause of disability and a major cause of mortality. Each year, more than 500,000 Americans sustain a stroke. Reperfusion and antithrombotic therapies are still of limited benefit, hence increasing interest has been focused on therapeutic approaches that prevent and/or modulate infarct evolution. Hyperglycemia in acute stroke has a poor prognosis and is associated with significant morbidity and mortality. However, it remains unclear whether intensive lowering of blood glucose levels in the hyperacute and acute phases of stroke improves clinical outcomes. Experimental data suggest that elevated blood glucose may contribute to infarct expansion directly through a number of maladaptive metabolic pathways and that treatment with insulin may attenuate these adverse effects. Despite some controversy surrounding the optimal level of blood glucose control, much of the evidence to date supports rigorous blood glucose control and comprehensive cardiovascular risk factor management to prevent stroke in patients with diabetes. The current recommendation is to aim for strict control of blood pressure, glucose, and lipids along with lifestyle modification to improve cardiovascular health. However, there remains a distinct paucity of information concerning secondary stroke prevention. To date, the overwhelming evidence suggests that aggressive glucose management should be the standard of care in all patients with stroke and hyperglycemia. This article presents an overview of the recommendations for the optimum control of blood glucose for prevention and treatment of ischemic and hemorrhagic stroke.
References and Recommended Reading
National Diabetes Information Clearinghouse (NDIC): National diabetes statistics, 2007. Available at http://www.diabetes.niddk.nih.gov/DM/PUBS/statistics. Accessed March 2009.
Kuusisto J, Mykkanen L, Pyorala K, Laakso M: Non-insulin-dependent diabetes and its metabolic control are important predictors of stroke in elderly subjects. Stroke 25:1157–1164.
The ACCORD Study Group: Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008, 358:2545–2559.CrossRef
The ADVANCE Collaborative Group: Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008, 358:2560–2572.CrossRef
Goldstein LB, Adams R, Becker K, et al.: Primary prevention of ischemic stroke: a statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke 2001, 32:280–299.PubMed
UK Prospective Diabetes Study Group: Intensive blood-glucose with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998, 352:837–853.CrossRef
National Heart, Lung, and Blood Institute: For safety, NHLBI changes intensive blood sugar treatment strategy in clinical trial of diabetes and cardiovascular disease [press release]. Available at http://public.nhlbi.nih.gov/newsroom/home/GetPressRelease.aspx?id=2551. Accessed March 2009.
UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998, 352:837–853.CrossRef
UK Prospective Diabetes Study (UKPDS) Group: Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998, 352:854–865.CrossRef
Matthews DR, Holman R: UKPDS 30 year data—are there legacy effects of improved glucose and blood pressure control? Presented at the 44th Annual Meeting of the European Association for the Study of Diabetes. Rome, Italy; September 7–11, 2008.
Levetan CS: Effect of hyperglycemia on stroke outcomes. Endocr Pract 2004, 10(Suppl 2):34–39.PubMed
The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group: Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med 2008, 359:1464–1476.CrossRef
Ligaray KP, Isley WL: Diabetes mellitus, type 2-endocrinology. Emedicine website. http://emedicine.medscape.com. Accessed August 6, 2008.
Votey SR, Peters AL: Diabetes mellitus, type 2—a review—emergency medicine. Emedicine website. http://emedicine.medscape.com. Accessed July 9, 2008.
Lamb WH: Diabetes mellitus, type 1—pediatrics: general medicine. Emedicine website. http://emedicine.medscape.com. Accessed October 19, 2007.
British National Formulary: BNF 57. Available at http://www.bnf.org/bnf/index.htm. Accessed March 2009.
National Institute for Health and Clinical Excellence: Type 2 diabetes. The management of type 2 diabetes. NICE clinical guideline 66. Available at http://www.nice.org.uk/nicemedia/pdf/CG66NICEGuideline.pdf. Accessed March 2009.
Munro N, Feher MD: Current, new, and emerging therapies for managing hyperglycaemia in type 2 diabetes. Br J Gen Pract Vol. 58:531–533.
- Optimum control of blood glucose for prevention and treatment of ischemic and hemorrhagic stroke
Current Treatment Options in Cardiovascular Medicine
Volume 11, Issue 3 , pp 201-211
- Cover Date
- Print ISSN
- Online ISSN
- Current Science Inc.
- Additional Links