Sugar and NICE - aggressive hyperglycaemic control in ischaemic stroke and what can we learn from non-neurological intensive glucose control trials in the critically ill?

摘要

Hyperglycaemia is a common phenomenon after cerebral ischaemia (for that matter, after most acute medical or surgical conditions), and clinicians have certainly been itching to treat. But should we? The devil is in the details.Continuous assessment of blood glucose levels and qualified treatment are often noted to be core components of specialized stroke care [1]. Expert statements have taken a somewhat sinusoidal course when discussing the matter. In 1994, the Stroke Council of the American Heart Association said that it may be a good idea to treat hyperglycaemia in patients with stroke just as one would treat hyperglycaemia in 'other persons with elevated blood glucose' [2]. The guideline was substantiated in 2003, with treatment then being warranted should blood glucose levels exceed 16.6 mmol/1 (300 mg/dl) [3].