Document Detail


Glucose Regulation in Acute Stroke Patients (GRASP) trial: a randomized pilot trial.
MedLine Citation:
PMID:  19834016     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Hyperglycemia is associated with worse outcome in patients with acute stroke.
METHODS: We conducted a prospective, randomized, multicenter, 3-arm trial (tight control [target 70 to 110 mg/dL], loose control [target 70 to 200 mg/dL], and control usual care [70 to 300 mg/dL]) to assess the feasibility and safety of 2 insulin infusion protocol targets in patients with acute ischemic stroke. The planned sample was 72 subjects.
RESULTS: A total of 74 subjects were enrolled. Seventy-two (97%) had data available for the primary analyses and 73 (99%) had 3-month clinical outcome data. Median age was 67 years, median National Institutes of Health Stroke Scale score was 8, median glucose was 163 mg/dL, and median time to randomization was 10.7 hours. Fifty-nine percent of patients were diabetic, 35% received thrombolysis, and 14% of subjects died within 3 months. The loose control and usual care groups had median glucose concentrations of 151 mg/dL. The tight control group had a median glucose concentration of 111 mg/dL. The loose control group spent 90% of the first 24 hours in target and the tight group 44% of time in target. There was only one symptomatic patient with hypoglycemia in the loose control group (4%) and zero in the tight control group. The overall rates of hypoglycemia (<55 mg/dL) were 4% in control, 4% in loose, and 30% in tight. Exploratory efficacy analysis was conducted.
CONCLUSIONS: Insulin infusion for patients with acute ischemic stroke is feasible and safe using the insulin infusion protocol in the Glucose Regulation in Acute Stroke Patients (GRASP) trial. Exploratory efficacy analysis supports further comparative study.
Authors:
Karen C Johnston; Christiana E Hall; Brett M Kissela; Thomas P Bleck; Mark R Conaway;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-10-15
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  40     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-25     Completed Date:  2010-01-12     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3804-9     Citation Subset:  IM    
Affiliation:
Department of Neurology, University of Virginia, PO Box 800394, Charlottesville, VA 22908, USA. Kj4v@virginia.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Aged, 80 and over
Blood Glucose / drug effects,  metabolism*
Feasibility Studies
Female
Humans
Hyperglycemia / drug therapy*,  metabolism,  mortality
Hypoglycemic Agents / administration & dosage*
Insulin / administration & dosage*
Male
Middle Aged
Pilot Projects
Prospective Studies
Stroke / metabolism*,  mortality
Grant Support
ID/Acronym/Agency:
R01 NS050192/NS/NINDS NIH HHS; R01 NS050192/NS/NINDS NIH HHS; R01 NS050192-03/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
0/Blood Glucose; 0/Hypoglycemic Agents; 0/Insulin
Comments/Corrections

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