(770) Hyperglycemia Occurrence in Enterally Fed Ischemic Stroke Patients

Introduction: Hyperglycemia following an acute ischemic stroke (AIS) has been linked to increased morbidity and mortality. Our institution revised its hospital-wide sliding scale insulin protocol to incorporate half-doses at midnight due to the risk of hypoglycemia when not eating. This study aimed to evaluate the safety and efficacy of administering half-dose sliding scale insulin (SSI) at midnight compared to full doses in AIS patients receiving enteral nutrition (EN).

Methods: This single-center, retrospective cohort study involved 151 patients diagnosed with AIS and receiving EN in a neurocritical care unit between January 1, 2014, and December 31, 2021. Patients were divided into two groups based on the dosage of SSI at midnight: full dose (FULL) and half dose (HALF). The primary outcome was the incidence of hyperglycemia observed over a 48-hour period after stability on EN. Secondary outcomes included new infections, incidence of hypoglycemia, and incidence of delirium.

Results: In the FULL group, 52 patients (71.2%) experienced hyperglycemia compared to 60 patients (76.9%) in the HALF group (risk difference 5.69% [95% CI: -8.30% to 19.68%]; p=0.0019), meeting statistical significance for non-inferiority. Delirium was significantly higher in the FULL group (32 [43.8%] vs. 10 [12.8%], p< 0.001), while the HALF group had a higher rate of suspected bacterial infections (32 [52.1%] vs. 54 [69.2%], p=0.0306).

Conclusions: The study indicates that administering half-dose SSI at midnight in AIS patients receiving EN is non-inferior to full doses in controlling hyperglycemia. However, differences in delirium and infection rates suggest that glycemic changes may influence other clinical outcomes.