Trial reportPloS one2015
Hyperglycaemia, insulin therapy and critical penumbral regions for prognosis in acute stroke: further insights from the INSULINFARCT trial.
Trial report in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00472381 (Assessment of Continuous Intravenous Insulin Protocol Versus Subcutaneous Insulin in Acute Ischemic Stroke), which is not on this map. Cited by 22 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Assessment of Continuous Intravenous Insulin Protocol Versus Subcutaneous Insulin in Acute Ischemic Stroke
Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.
- Blood glucose level affects prognosis of patients who received intravenous thrombolysis after acute ischemic stroke? A meta-analysis.Frontiers in endocrinology · 2023Pooled it
- Detrimental Effect of Acute Hyperglycemia on the Outcomes of Large Ischemic Region Stroke.Journal of the American Heart Association · 2024Trial
- The Association Between Stress Hyperglycemia Ratio and Short-Term Outcomes After Successful Recanalization by Mechanical Thrombectomy in Acute Ischemic Stroke Patients.Brain and behavior · 2025Article
- Risk prediction model for poor prognosis after intravenous thrombolysis among ischemic stroke patients aged ≥ 80 years and analysis of follow-up.Scientific reports · 2025Article
- Fasting Blood Glucose on Prognosis After Acute Large Vessel Occlusion Reperfusion- A Multi-Center Study Based on Propensity Score Matching.Vascular health and risk management · 2025Article
- Dual-trajectory of TyG levels and lifestyle scores and their associations with ischemic stroke in a non-diabetic population: a cohort study.Cardiovascular diabetology · 2024Article
- Increased stress hyperglycemia ratio at hospital admission in stroke patients are associated with increased in-hospital mortality and length of stay.Diabetology & metabolic syndrome · 2024Article
- Functional long-term outcome following endovascular thrombectomy in patients with acute ischemic stroke.Neurological research and practice · 2024Article
- Pre-diabetes, Diabetes, Hyperglycemia, and Stroke: Bittersweet Therapeutic Opportunities.Current neurology and neuroscience reports · 2022Review
- Association of diabetes mellitus and admission glucose levels with outcome after endovascular therapy in acute ischaemic stroke in anterior circulation.European journal of neurology · 2022Observational
- Crosstalk between neurological, cardiovascular, and lifestyle disorders: insulin and lipoproteins in the lead role.Pharmacological reports : PR · 2022Review
- Thrombectomy for Comatose Patients with Basilar Artery Occlusion : A Multicenter Study.Clinical neuroradiology · 2021Article
- A J-Shaped Curve Relationship Between Baseline Fasting Blood Glucose and 1-Year Stroke Recurrence in Non-diabetic Patients With Acute Cerebral Infarction in Xi'an, China: A Multicenter Observational Cohort Study.Frontiers in neurology · 2021Article
- Stress Hyperglycemia and Outcome of Non-diabetic Patients After Acute Ischemic Stroke.Frontiers in neurology · 2019Article
- Association between Blood Glucose and cardiac Rhythms during pre-hospital care of Trauma Patients - a retrospective Analysis.Scandinavian journal of trauma, resuscitation and emergency medicine · 2018Article
- Long-term treatment of diabetic rats with vanadyl sulfate or insulin attenuate acute focal cerebral ischemia/reperfusion injury via their antiglycemic effect.Metabolic brain disease · 2018Article
- No Association between Elevated 2-h Postprandial Blood Glucose Levels and Functional Outcomes of Small-Artery Occlusion in Patients with Diabetes.Frontiers in neurology · 2018Article
- c-Jun N-Terminal Kinases (JNKs) in Myocardial and Cerebral Ischemia/Reperfusion Injury.Frontiers in pharmacology · 2018Review
- Insulin resistance in ischemic stroke.Metabolic brain disease · 2017Review
- Hyperglycemia is associated with more severe cytotoxic injury after stroke.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2017Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRecently, the concept of 'clinically relevant penumbra' was defined as an area saved by arterial recanalization and correlated with stroke outcome. This clinically relevant penumbra was located in the subcortical structures, especially the periventricular white matter. Our aims were to confirm this hypothesis, to investigate the impact of admission hyperglycemia and of insulin treatment on the severity of ischemic damages in this area and to study the respective contributions of infarct volume and ischemic damage severity of the clinically relevant penumbra on 3-month outcome.
methodsWe included 99 patients from the INSULINFARCT trial. Voxel-Based Analysis was carried on the Apparent Diffusion Coefficient (ADC) maps obtained at day one to localize the regions, which were more damaged in patients i) with poor clinical outcomes at three months and ii) without arterial recanalization. We determined the intersection of the detected areas, which represents the clinically relevant penumbra and investigated whether hyperglycemic status and insulin regimen affected the severity of ischemic damages in this area. We performed logistic regression to examine the contribution of infarct volume or early ADC decrease in this strategic area on 3-month outcome.
findingsLower ADC values were found in the corona radiata in patients with poor prognosis (p< 0.0001) and in those without arterial recanalization (p< 0.0001). The tracking analysis showed that lesions in this area interrupted many important pathways. ADC values in this area were lower in hyperglycemic than in normoglycemic patients (average decrease of 41.6 ± 20.8 x10(-6) mm2/s) and unaffected by the insulin regimen (p: 0.10). ADC values in the clinically relevant penumbra, but not infarct volumes, were significant predictors of 3-month outcome.
conclusionThese results confirm that the deep hemispheric white matter is part of the clinically relevant penumbra and show that hyperglycaemia exacerbates the apparition of irreversible ischemic damage within 24 hours in this area. However, early intensive insulin therapy fails to protect this area from infarction.
trial registrationClinicalTrials.gov NCT00472381.
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