Preview

Problems of Endocrinology

Advanced search

Insulin therapy of type 2 diabetes mellitus in the period of acute stroke: the importance of the insulin administration technique

https://doi.org/10.14341/probl20146054-8

Abstract

Hyperglycemia in the period of acute stroke aggravates prognosis of its outcome in the patients with type 2 diabetes mellitus (DM2). The objective of the present study was to compare the effectiveness and safety of intravenous and subcutaneous ad- ministration of insulin to the patients presenting with DM2 in the period of acute stroke for the achievement of the same target blood glucose level of 7.8-10.0 mmol/l. At admission, the patients were randomized into two groups to be treated either with intravenous (n=36) or subcutaneous (n=37) injections of insulin. Intravenous insulin therapy resulted in a more favourable dynamics of the clinical course of the stroke patients estimated based on the National Institute of Health stroke scale (NIHSS) (p<0.001) and the activity of daily living (ADL) index (p<0.01). Moreover, it was associated with a reduced variability of glyce- mia (p<0.01) and a lower frequency of hypoglycemic episodes (p=0.019) compared with subcutaneous injections.

About the Authors

Leonid G Strongin
Nizhni Novgorod State Medical Academy
Russian Federation


I G Grigoryan
Nizhni Novgorod State Medical Academy
Russian Federation


A V Gustov
Nizhni Novgorod State Medical Academy
Russian Federation


N G Belyaeva
Nizhni Novgorod State Medical Academy
Russian Federation


References

1. Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients: A Systematic Overview. Stroke. 2001;32(10):2426-2432. doi: 10.1161/hs1001.096194

2. Вагапова Г.Р., Хасанова Д.Р., Нефедьева Д.Л., Демин Т.В. Особенности течения острого ишемического инсульта у больных сахарным диабетом 2-го типа. // Казанский медицинский журнал. – 2008. – Т. 89. – №6. – С. 795-800. [Vagapova GR, Hasanova DR, Nefed'eva DL, Demin TV. Osobennosti techeniya ostrogo ishemicheskogo insul'ta u bol'nyh saharnym diabetom 2-go tipa. Kazanskiy meditsinskiy zhurnal. 2008;89(6):795-800].

3. Johnston KC, Hall CE, Kissela BM, Bleck TP, Conaway MR. Glucose Regulation in Acute Stroke Patients (GRASP) Trial: A Randomized Pilot Trial. Stroke. 2009;40(12):3804-3809. doi: 10.1161/strokeaha.109.561498

4. Quinn TJ, Lees KR. Hyperglycaemia in Acute Stroke &ndash; To Treat or Not to Treat. Cerebrovascular Diseases. 2009;27(1):148-155. doi: 10.1159/000200453

5. Bruno A, Kent TA, Coull BM, Shankar RR, Saha C, Becker KJ, et al. Treatment of Hyperglycemia In Ischemic Stroke (THIS): A Randomized Pilot Trial. Stroke. 2007;39(2):384-389. doi: 10.1161/strokeaha.107.493544

6. Демидова И.Ю., Макова А.Г. Интенсивная инсулинотерапия при остром нарушении мозгового кровообращения. // Фарматека. – 2011. – №3. – С. 69-71. [Demidova IYu, Makova AG. Intensivnaya insulinoterapiya pri ostrom narushenii mozgovogo krovoobrascheniya. Farmateka. 2011;(3):69-71].

7. Kansagara D, Fu R, Freeman M, Wolf F, Helfand M. Intensive Insulin Therapy in Hospitalized Patients: A Systematic Review. Annals of Internal Medicine. 2011;154(4):268. doi: 10.7326/0003-4819-154-4-201102150-00008

8. Intensive versus Conventional Glucose Control in Critically Ill Patients. New England Journal of Medicine. 2009;360(13):1283-1297. doi: 10.1056/NEJMoa0810625

9. Эндокринология. Национальное руководство. / Под ред. И.И. Дедова, Г.А. Мельниченко. – М.: ГЭОТАР-Медиа; 2008. 1072 с. [Endocrinology: National Guidelines. Ed by I.I. Dedov, G.A. Mel'nichenko. Moscow: GEOTAR-Media; 2008. 1072 p.]

10. Неврология. Национальное руководство. / Под ред. Е.И. Гусева, А.Н. Коновалова, В.И. Скворцовой, А.Б. Гехт. – М.: ГЭОТАР-Медиа, 2009. 1040 с. [Neurology: National Guidelines. Ed by E.I. Gusev, A.N. Konovalov, V.I. Skvortsova, A.B. Gekht. Moscow: GEOTAR-Media; 2009. 1040p.]

11. Service FJ, Molnar GD, Rosevear JW, Ackerman E, Gatewood LC, Taylor WF. Mean amplitude of glycemic excursions, a measure of diabetic instability. Diabetes. 1970;19(9):644-655. doi:10.2337/diab.19.9.644

12. Белова А.Н. Шкалы, тесты и опросники в неврологии и нейрохирургии. Руководство для врачей и научных сотрудников. – М.: Антидор; 2004. C. 32-35. [Belova AN. Shkaly, testy i oprosniki v nevrologii i neyrohirurgii. Rukovodstvo dlya vrachey i nauchnyh sotrudnikov. Moscow: Antidor; 2004. - P. 32-35.]

13. Dossett LA, Cao H, Mowery NT, Dortch MJ, Morris JM, Jr., May AK. Blood glucose variability is associated with mortality in the surgical intensive care unit. American Surgeon. 2008 Aug;74(8):679-685; discussion 685.

14. Dungan KM, Braithwaite SS, Preiser J-C. Stress hyperglycaemia. The Lancet. 2009;373(9677):1798-1807. doi: 10.1016/s0140-6736(09)60553-5

15. Kreisel SH, Berschin UM, Hammes H-P, Leweling H, Bertsch T, Hennerici MG, et al. Pragmatic Management of Hyperglycaemia in Acute Ischaemic Stroke: Safety and Feasibility of Intensive Intravenous Insulin Treatment. Cerebrovascular Diseases. 2009;27(2):167-175. doi: 10.1159/000185608.


Review

For citations:


Strongin L.G., Grigoryan I.G., Gustov A.V., Belyaeva N.G. Insulin therapy of type 2 diabetes mellitus in the period of acute stroke: the importance of the insulin administration technique. Problems of Endocrinology. 2014;60(5):4-8. (In Russ.) https://doi.org/10.14341/probl20146054-8

Views: 532


ISSN 0375-9660 (Print)
ISSN 2308-1430 (Online)