Exploring the correlation between corrective glucose treatment and long-term patient outcomes: a SHINE secondary analysis.

Abstract

Introduction: Glucose control is an important aspect of acute ischemic stroke management. Although absolute glucose concentration remains the focus in clinical stroke care, glucose variability is increasingly recognized as a viable treatment target. To assess the relationship between acute post-stroke glycemic control parameters and patient outcomes, we reanalyzed the data from the first 8 h of treatment for patients in the Stroke Hyperglycemia Insulin Network Effort (SHINE) clinical trial, when glycemic variability is highest.

Methods: In this secondary analysis of the SHINE dataset, the rate of glucose change during the first 8 h was evaluated for its association with patient outcomes, dichotomized as modified Rankin scale (mRS) 0-2 versus 3-6, using logistic regression and a linear mixed-effects model.

Results: Unadjusted analysis of the glucose correction period during the first 8 h suggested that patients with mRS 3-6 had a faster glucose correction compared to those with mRS 0-2 (-8.9 and -6.7 mg/dL/h, p < 0.001). This finding remained statistically significant in both the intensive intervention group and the poorly controlled diabetic sub-group (glycosylated hemoglobin [HbA1c] ≥ 6.4). Mixed-effects models also indicated a significant difference in the rate of glucose change (1.9 mg/dL/h, p < 0.001) between outcome groups (mRS 0-2 versus 3-6) across both treatment and HbA1c sub-groups.

Conclusion: Analysis of the first 8 h of the SHINE data suggests that early, rapid correction of glucose is associated with poor outcomes, particularly in the sub-group of patients with HbA1c ≥ 6.4. Further research is warranted to assess early glycemic correction as a possible personalized glucose management goal.