Systematic review of randomized controlled trials to regulate glycaemia after stroke.

AIM: This article presents the results of a systematic review of randomized controlled trials on the regulation of glycaemia among adults admitted to hospital with acute stroke.BACKGROUND: Hyperglycaemia is commonly observed in acute stroke. International stroke guidelines recommend that hyperglycaemia is treated after stroke. Nurses have a key role in the monitoring and management of glycaemia.DESIGN: Systematic review.DATA SOURCES: A search for randomized controlled trials was conducted in MEDLINE and PubMed electronic databases, and original papers published between January 1996-June 2011 were identified. The search was performed using the terms 'stroke', 'hyperglycaemia', and 'treatment' combined. Searching of citations from identified studies was also used to supplement electronic searches. The search was limited to adults and English language publications.REVIEW METHODS: A systematic review was conducted for eight studies, meeting the inclusion criteria that: (i) insulin protocols were subjected to randomized controlled trial; and that (ii) only adults admitted to hospital with acute stroke were sampled. The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting standards.RESULTS: Intensive insulin therapy regimes have been investigated in a total of eight trials. Intravenous insulin therapy significantly lowers glucose levels when compared with controls but adherence to glucose monitoring and treatment protocols appeared to pose considerable challenge on nurses in routine stroke care. Trials conducted to date have been on poor to sound quality.CONCLUSION: There is currently no substantive evidence to support aggressive glucose lowering in the acute phase of stroke. Well-conducted, large randomized controlled trials are required.