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Vol. 216. Issue 2.
Pages 92-98 (March 2016)
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Vol. 216. Issue 2.
Pages 92-98 (March 2016)
Review
DOI: 10.1016/j.rceng.2015.08.002
Treatment of hyperglycemia in patients with acute stroke
Tratamiento de la hiperglucemia en pacientes con ictus agudo
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L. Castilla-Guerraa,
Corresponding author
castillafernandez@hotmail.com

Corresponding author.
, M.C. Fernández-Morenob, J. Hewittc
a Servicio de Medicina Interna, Hospital de la Merced, Osuna, Sevilla, Spain
b Servicio de Neurología, Hospital de Valme, Universidad de Sevilla, Sevilla, Spain
c Institute of Primary Care & Public Health, Cardiff University School of Medicine, WCAT Lead – Geriatric & Stroke Medicine, Cardiff, United Kingdom
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Table 1. Main studies with insulin for controlling glycemia in acute ischemic stroke.
Table 2. Current recommendations for controlling hyperglycemia in acute ischemic stroke.
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Abstract

The proportion of diabetic patients who are hospitalized for stroke has been increasing in recent years, currently reaching almost a third of all cases of stroke. In addition, about half of patients with acute stroke present hyperglycemia in the first hours of the stroke.

Although hyperglycemia in the acute phase of stroke is associated with a poor prognosis, its treatment is currently a topic of debate. There is no evidence that the adminstration of intravenous insulin to these patients offers benefits in terms of the evolution of the stroke. New studies in development, such as the SHINE study (Stroke Hyperglycemia Insulin Network Effort), may contribute to clarifying the role of intensive control of glycemia during the acute phase of the stroke.

Ultimately, patients who have presented with stroke should be screened for diabetes.

Keywords:
Hyperglycemia
Diabetes
Acute stroke
Insulin
Diagnosis
Treatment
Resumen

La proporción de pacientes diabéticos hospitalizados por ictus ha ido aumentando en los últimos años, alcanzando en la actualidad casi un tercio de todos los ictus. Además, prácticamente la mitad de los enfermos con ictus agudo pueden presentar hiperglucemia en las primeras horas del evento.

A pesar de que la hiperglucemia en la fase aguda del ictus se asocia a un peor pronóstico, su tratamiento es en la actualidad motivo de controversia. No existen evidencias de que la administración de insulina por vía intravenosa en estos pacientes proporcione beneficios en la evolución del ictus. Nuevos estudios en desarrollo, como el estudio Stroke Hyperglycemia Insulin Network Effort (SHINE), posiblemente contribuyan a aclarar el papel del control intensivo de la glucemia durante la fase aguda del ictus.

Finalmente, los pacientes que han presentado un ictus deberían ser sometidos a un cribado de diabetes.

Palabras clave:
Hiperglucemia
Diabetes
Ictus agudo
Insulina
Diagnóstico
Tratamiento

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