European Stroke Organisation (ESO) Guidelines on Glycaemia Management in Acute Stroke

Overview

Journal Eur Stroke J

Specialties Cardiology & Vascular Diseases
Neurology

Date 2019 Apr 23

PMID 31008333

Citations 19

Authors

Blanca Fuentes

George Ntaios

Jukka Putaala

Brenda Thomas

Guillaume Turc

Exuperio Diez-Tejedor

Affiliations

Soon will be listed here.

Abstract

Background: Hyperglycaemia is a frequent complication in acute stroke that has been shown to be independently associated with larger infarct size, haematoma growth, poor clinical outcome and mortality. This Guideline Document presents the European Stroke Organisation (ESO) Guidelines for the management of blood glucose levels in patients with acute ischemic or haemorrhagic stroke.

Methods: The working group identified related questions and developed its recommendations based on evidence from randomised controlled trials following the standard operating procedure of the ESO. This Guideline Document was reviewed and approved by the European Stroke Organisation Guidelines Committee and the European Stroke Organisation Executive Committee.

Results: We found low-quality evidence from clinical trials in ischemic or haemorrhagic stroke exploring the use of intravenous insulin aimed to achieve a tight glycaemic control with different glucose level targets and several other sources of heterogeneity. None of these trials neither the meta-analysis of them have demonstrated any significant benefit of tight glycaemic control with intravenous insulin in acute ischemic or haemorrhagic stroke patients on functional outcome or in survival and they have shown an increased risk for hypoglycaemia.

Conclusions: We suggest against the routine use of tight glycaemic control with intravenous insulin as a means to improve outcomes. The currently available data about the management of glycaemia in patients with acute stroke are limited and the strengths of the recommendations are therefore weak. Nevertheless, this does not prevent that hyperglycaemia in acute stroke patients could be treated as any other hospitalised patient.

Citing Articles

Stress-Induced Hyperglycemia Predicts Poor Outcomes in Primary Intracerebral Hemorrhage Patients.

Gilotra K, Basem J, Janssen M, Swarna S, Mani R, Ren B NeuroSci. 2025; 6(1).

PMID: 39982264 PMC: 11843840. DOI: 10.3390/neurosci6010012.

[Recent clinical studies and the S3 guidelines on stroke].

Reith W, Bachhuber A Radiologie (Heidelb). 2025; 65(2):94-99.

PMID: 39833453 DOI: 10.1007/s00117-024-01415-9.

Impact of glycemic treatment and blood glucose monitoring on outcomes in patients with acute ischemic stroke without prior diabetes: a longitudinal cohort study.

Yang H, Chien W, Liaw J, Yang C, Chung C, Huang S Diabetol Metab Syndr. 2024; 16(1):302.

PMID: 39696458 PMC: 11657440. DOI: 10.1186/s13098-024-01542-2.

[Glycemic management in the stroke unit and its relationship with morbidity and mortality].

Ruiz-Hernandez A, Gonzalez-Arnaiz E, Gonzalez-Puente I, Tejada-Garcia J, Beltran-Rodriguez I, Garcia Tunon-Villaluenga L Rev Neurol. 2024; 79(8):209-215.

PMID: 39404034 PMC: 11605905. DOI: 10.33588/rn.7908.2023337.

Glycaemia and ischaemia-reperfusion brain injury in patients with ischaemic stroke treated with mechanical thrombectomy (GLIAS-MT): an observational, unicentric, prospective study protocol.

Hervas C, Peiroten I, Gonzalez L, Alonso de Lecinana M, Alonso-Lopez E, Casado L BMJ Open. 2024; 14(8):e086745.

PMID: 39117402 PMC: 11404171. DOI: 10.1136/bmjopen-2024-086745.

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