ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1567766
Exploring corrective glucose treatment and long-term patient outcomes correlation: a SHINE secondary analysis
Provisionally accepted
- 1Georgia Institute of Technology, Atlanta, Georgia, United States
- 2Emory University, Atlanta, United States
- 3University of Virginia, Charlottesville, Virginia, United States
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Introduction: Glucose control is an important aspect of acute ischemic stroke management. However, though absolute glucose concentration remains the focus in clinical stroke care, glucose variability is increasingly recognized as a viable treatment target. To assess patient-parameters related to the acute post-stroke glycemic control with outcomes, we reanalyzed the first 8 hours of treatment for patients in the Stroke Hyperglycemia Insulin Network Effort (SHINE) clinical trial dataset, where glycemic variability is highest. Methods: In this secondary analysis of the SHINE dataset, rate of glucose change during the first 8 hours was evaluated for association with patient outcome dichotomized to modified Rankin scale (mRS) 0-2 vs 3-6 using logistic regression and a linear mixed model effect. Results: Unadjusted analysis of the glucose correction period occurring in the first 8 hours suggested that patients with mRS 3-6 had a faster glucose correction compared to those with 0-2 (-8.9 and -6.7mg/dL/hr, 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 effect models also indicate a significant difference in the rate of glucose change (1.9mg/dL/hr, p<0.001) between outcome groups (mRS 0-2 vs. 3-6) in both treatment and HbA1c sub-groups.Conclusions: Analysis of the first 8 hours 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.
Keywords: Acute ischemic stroke, Glucose variability, glycemic control, Relative hypoglycemia, Patient outcomes
Received: 28 Jan 2025; Accepted: 28 Apr 2025.
Copyright: © 2025 Horton, Patel, Hall, Johnston, Mei and Sadan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ofer Sadan, Emory University, Atlanta, United States
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