# Exploring the correlation between corrective glucose treatment and long-term patient outcomes: a SHINE secondary analysis

## TL;DR

This study found that rapid glucose correction in the first 8 hours after stroke is linked to worse long-term outcomes, especially in patients with higher HbA1c levels.

## Contribution

The study introduces a novel analysis of glucose correction rates in acute stroke care and their association with patient outcomes.

## Key findings

- Patients with worse outcomes (mRS 3–6) had faster glucose correction (−8.9 mg/dL/h) compared to those with better outcomes (−6.7 mg/dL/h).
- The association remained significant in both the intensive intervention group and the poorly controlled diabetic subgroup (HbA1c ≥ 6.4).
- Mixed-effects models confirmed a significant difference in glucose change rates between outcome groups across treatment and HbA1c subgroups.

## Abstract

Glucose control is an important aspect of acute ischemic stroke management. Although absolute glucose concentration remains the focus in clinical stroke care, glucose variability is increasingly recognized as a viable treatment target. To assess the relationship between acute post-stroke glycemic control parameters and patient outcomes, we reanalyzed the data from the first 8 h of treatment for patients in the Stroke Hyperglycemia Insulin Network Effort (SHINE) clinical trial, when glycemic variability is highest.

In this secondary analysis of the SHINE dataset, the rate of glucose change during the first 8 h was evaluated for its association with patient outcomes, dichotomized as modified Rankin scale (mRS) 0–2 versus 3–6, using logistic regression and a linear mixed-effects model.

Unadjusted analysis of the glucose correction period during the first 8 h suggested that patients with mRS 3–6 had a faster glucose correction compared to those with mRS 0–2 (−8.9 and −6.7 mg/dL/h, p < 0.001). This finding remained statistically significant in both the intensive intervention group and the poorly controlled diabetic sub-group (glycosylated hemoglobin [HbA1c] ≥ 6.4). Mixed-effects models also indicated a significant difference in the rate of glucose change (1.9 mg/dL/h, p < 0.001) between outcome groups (mRS 0–2 versus 3–6) across both treatment and HbA1c sub-groups.

Analysis of the first 8 h of the SHINE data suggests that early, rapid correction of glucose is associated with poor outcomes, particularly in the sub-group of patients with HbA1c ≥ 6.4. Further research is warranted to assess early glycemic correction as a possible personalized glucose management goal.