Abstract WP378: Insulin in the Management of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Background: The role of tight glycemic control in the management of acute ischemic stroke remains uncertain. Objective: Our goal is to evaluate the effects of tight glucose control with insulin therapy after acute ischemic stroke. Methods: We searched PubMed, CENTRAL, and EMBASE for randomized controlled trials (RCTs) that evaluated the effects of tight glycemic control (70 - 135 mg/dL) in acute ischemic stroke. Analysis was performed using fixed- and random-effects models. Outcomes were death, independence and modified Rankin Scale (mRS) score at ≥90 days follow-up, and symptomatic or severe hypoglycemia during treatment. Results: Twelve RCTs including 2,734 patients were included. When compared to conventional therapy or placebo, tight glycemic control was associated with similar rates of mortality at ≥90 days follow-up (pooled odds ratio [pOR], 0.99 [95% CI, 0.79 - 1.22], I 2 0%), independence at ≥90 days follow-up (pOR, 0.95 [0.79 - 1.14], I 2 0%) and mRS scores at ≥90 days follow-up (standardized mean difference, 0.014 [-0.15 - 0.17], I 2 0%). In contrast, tight glycemic control was associated with increased rates of symptomatic or severe hypoglycemia during treatment (pOR 5.2 [1.87 - 14.42], I 2 20%). Conclusion: Tight glucose control after acute ischemic stroke is not associated with improvements in mortality, independence or mRS score and leads to higher rates of symptomatic or severe hypoglycemia.

2 Advances in oral and insulin treatments for diabetes

Prevalence of type 2 diabetes is rising worldwide, and adding significant burdens of morbidity, mortality and financial costs to healthcare systems worldwide. Whilst cardiovascular risk reduction is central to diabetes management, improved glycaemic control remains an important aim of management, in order to reduce the risk of microvascular complications.In this presentation, I hope to remind the audience why diabetes is such an important condition, to review the evidence behind tight glucose control, and to assess the options and evidence behind newer oral and injectable therapies in the management of glucose in type 2 diabetes. I will also discuss recent studies concerning the prevention and remission of type 2 diabetes.Finally, I hope to highlight the huge potential value of new technology in the management of Type 1 diabetes, which is set to change the treatment of this condition completely in the next few years.