Hyperglycemia is associated with enhanced cortical toxicity and larger infarct volumes following focal cerebral ischemia. Initial blood glucose in acute ischemic stroke patients may also contribute to a differential response to thrombolysis (i.e., administration of tissue plasminogen activator (t-PA)) and affect risk of symptomatic intracerebral hemorrhage (sICH). The Stroke Hyperglycemia Insulin Network Effort (SHINE) study is a phase III single-blinded, randomized control trial comparing an intensive level of glucose control with standard of care glucose control in hyperglycemic stroke patients. In stratifying randomization by treatment with intravenous t-PA, the SHINE trial offers a unique opportunity to evaluate an association between euglycemic control and outcomes from stroke thrombolysis in a prospective, comparative study. We hypothesize that normalization of blood glucose in the acute stroke setting may reduce risk of thrombolysis-induced sICH. With enrollment recently underway, the stratified results from the SHINE trial could substantially influence future treatment decisions for hyperglycemic stroke patients.
© 2012 New York Academy of Sciences.