Clinical relevance of glucose metrics during the early brain injury period after aneurysmal subarachnoid hemorrhage: An opportunity for continuous glucose monitoring

Abstract

Hyperglycaemia, hypoglycaemia and higher glucose variability during the Early Brain Injury (EBI) period of aneurysmal subarachnoid hemorrhage (aSAH) have been associated with poor clinical outcome. However, it is unclear whether these associations are due to direct glucose-driven injury or if hyperglycaemia simply acts as a marker of initial severity. Actually, strict glucose control with intensive insulin therapy has not been demonstrated as an effective strategy for improving clinical outcomes after aSAH. Currently published studies describing an association between hyperglycaemia and prognosis in aSAH patients have been based on isolated glucose measurements and did not incorporate comprehensive dynamic evaluations, such as those derived from subcutaneous continuous glucose monitoring devices (CMG). Arguably, a more accurate knowledge on glycaemic patterns during the acute phase of aSAH could increase our understanding of the relevance of glycaemia as a prognostic factor in this disease as well as to underpin its contribution to secondary focal and diffuse brain injury. Herein, we have summarized the available evidence on the diagnostic and prognostic relevance of glucose metrics during the acute phase of cerebrovascular diseases, focusing in the EBI period after aSAH. Overall, obtaining a more precise scope of acute longitudinal glucose profiles could eventually be useful for improving glucose management protocols in the setting of acute aSAH and to advance toward a more personalized management of aSAH patients during the EBI phase.

Near-Infrared Spectroscopy: A Free-Living Neuroscience Tool to Better Understand Diabetes and Obesity

“…Furthermore, glycemic variability was found to be associated with cerebral metabolic distress (defined as lactate/pyruvate ratio >40), as well as hospital mortality, after subarachnoid hemorrhage [ 96 ]. On the other hand, a recent study emphasized that it was still partially unclear whether the association between glycemic variability and brain dysfunction following subarachnoid hemorrhage was due to direct deleterious effects induced by glucose dysregulation or if hyperglycemia was an epiphenomenon related to initial bleeding severity [ 97 ]. The study concluded that further research was needed to understand the most appropriate and informative timing for glucose monitoring and how to combine different glucose metrics with markers of brain injury [ 97 ].…”

“…On the other hand, a recent study emphasized that it was still partially unclear whether the association between glycemic variability and brain dysfunction following subarachnoid hemorrhage was due to direct deleterious effects induced by glucose dysregulation or if hyperglycemia was an epiphenomenon related to initial bleeding severity [ 97 ]. The study concluded that further research was needed to understand the most appropriate and informative timing for glucose monitoring and how to combine different glucose metrics with markers of brain injury [ 97 ]. The importance of selecting the most appropriate metrics for CGM data analysis for the study of brain function was also indicated in another recent study, which showed that, in T2DM patients, the glucose coefficient of variation (CV) and time below range (TBR) were not associated with any of the investigated aspects of cognitive function [ 98 ].…”

Glycemic Variability and Prognosis of Patients with Intracerebral Hemorrhage: A Meta-Analysis

“…[11]. Although some pilot studies have observed the association between acute GV and clinical outcomes in patients with ICH [10,[17][18][19][20][21][22][23], the results were not consistent [24]. Therefore, in this study, we performed a meta-analysis to systematically evaluate the association between acute GV and prognosis in patients with ICH.…”