Insulin for glycaemic control in acute ischaemic stroke

M Fernanda Bellolio; Rachel M Gilmore; Latha Ganti

doi:10.1002/14651858.CD005346.pub4

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Figure 1

Study flow diagram.

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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 Dependency or death, Outcome 1 Dependency or death at the end of the follow‐up.

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Analysis 1.2

Comparison 1 Dependency or death, Outcome 2 Death.

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Analysis 1.3

Comparison 1 Dependency or death, Outcome 3 Diabetes mellitus versus no diabetes mellitus.

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Analysis 1.4

Comparison 1 Dependency or death, Outcome 4 Less than 30 days versus 90 days of follow‐up.

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Analysis 2.1

Comparison 2 Functional neurological outcome, Outcome 1 NIHSS or ESS at the end of the follow‐up.

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Analysis 2.2

Comparison 2 Functional neurological outcome, Outcome 2 Independent in daily activities.

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Analysis 2.3

Comparison 2 Functional neurological outcome, Outcome 3 Diabetes mellitus versus no diabetes mellitus.

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Analysis 2.4

Comparison 2 Functional neurological outcome, Outcome 4 Less than 30 days versus 90 days of follow‐up.

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Analysis 3.1

Comparison 3 Hypoglycaemia, Outcome 1 Symptomatic hypoglycaemia.

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Analysis 3.2

Comparison 3 Hypoglycaemia, Outcome 2 Hypoglycaemia (with or without symptoms).

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Analysis 4.1

Comparison 4 Mean glucose level, Outcome 1 Mean glucose level.

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Table 1. Risk of bias summary

Study	Generation of randomisation	Allocation concealment	Blinding: participants and physicians	Blinding: outcome to allocation group	Lost to follow‐up (%)
Vinychuk 2005	Low risk	Low risk	High risk	High risk	0
GIST‐UK 2007	Low risk	Low risk	High risk	Low risk	7.4
Staszewski 2011	Low risk	High risk	High risk	Low risk	0
THIS 2008	Low risk	Low risk	High risk	Low risk	0
Walters 2006	Low risk	Low risk	High risk	High risk	0
GRASP 2009	Low risk	Low risk	High risk	Low risk	1.4
Kreisel 2009	Low risk	Unclear risk	High risk	High risk	10
McCormick 2010	Low risk	Unclear risk	Unclear risk	High risk	Not reported
INSULINFARCT 2012	Low risk	Low risk	High risk	High risk	2.2
Vriesendorp 2009	High risk	High risk	High risk	High risk	15.2
Azevedo 2009	Low risk	Unclear risk	High risk	High risk	Not reported

Table 1. Risk of bias summary

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Comparison 1. Dependency or death

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Dependency or death at the end of the follow‐up Show forest plot	9	1516	Odds Ratio (M‐H, Fixed, 95% CI)	0.99 [0.79, 1.23]

2 Death Show forest plot	9	1422	Odds Ratio (M‐H, Fixed, 95% CI)	1.09 [0.85, 1.41]

3 Diabetes mellitus versus no diabetes mellitus Show forest plot	8	1482	Odds Ratio (M‐H, Fixed, 95% CI)	0.97 [0.77, 1.21]

3.1 Diabetes mellitus	3	194	Odds Ratio (M‐H, Fixed, 95% CI)	0.66 [0.35, 1.24]
3.2 No diabetes mellitus	6	1288	Odds Ratio (M‐H, Fixed, 95% CI)	1.02 [0.81, 1.30]
4 Less than 30 days versus 90 days of follow‐up Show forest plot	9	1516	Odds Ratio (M‐H, Fixed, 95% CI)	0.99 [0.79, 1.23]

4.1 30 days	5	289	Odds Ratio (M‐H, Fixed, 95% CI)	0.74 [0.43, 1.25]
4.2 90 days	4	1227	Odds Ratio (M‐H, Fixed, 95% CI)	1.05 [0.82, 1.34]

Comparison 1. Dependency or death

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Comparison 2. Functional neurological outcome

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 NIHSS or ESS at the end of the follow‐up Show forest plot	8	1432	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.09 [‐0.19, 0.01]

2 Independent in daily activities Show forest plot	9	1224	Odds Ratio (M‐H, Fixed, 95% CI)	1.03 [0.81, 1.32]

3 Diabetes mellitus versus no diabetes mellitus Show forest plot	8	1432	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.07 [‐0.18, 0.03]

3.1 Diabetes mellitus	3	146	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.06 [‐0.43, 0.31]
3.2 No diabetes mellitus	6	1286	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.08 [‐0.19, 0.03]
4 Less than 30 days versus 90 days of follow‐up Show forest plot	8	1432	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.09 [‐0.19, 0.01]

4.1 30 days	5	273	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.47 [‐0.72, ‐0.23]
4.2 90 days	3	1159	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.00 [‐0.12, 0.11]

Comparison 2. Functional neurological outcome

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Comparison 3. Hypoglycaemia

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Symptomatic hypoglycaemia Show forest plot	10	1455	Odds Ratio (M‐H, Fixed, 95% CI)	14.60 [6.62, 32.21]

2 Hypoglycaemia (with or without symptoms) Show forest plot	10	1455	Odds Ratio (M‐H, Fixed, 95% CI)	18.41 [9.09, 37.27]

Comparison 3. Hypoglycaemia

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Comparison 4. Mean glucose level

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mean glucose level Show forest plot	8	1398	Mean Difference (IV, Fixed, 95% CI)	‐0.63 [‐0.80, ‐0.46]

Comparison 4. Mean glucose level

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