Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke

Williams, Linda S.; Rotich, Joseph K.; Qi, Rong; Fineberg, Naomi S.; Espay, Alberto J.; Bruno, Askiel; Fineberg, S. Edwin; Tierney, William I.

doi:10.1212/wnl.59.1.67

Cited by 396 publications

(265 citation statements)

References 31 publications

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“…Post-stroke hyperglycaemia has been associated with poor outcome [21], but seems to particularly affect outcome in patients without diabetes. In a meta-analysis, the relative risk of in-hospital 30-day mortality in patients with admission hyperglycaemia (>6.1-7.0 mmol/L) was 3.28 (95% CI 2.32 to 4.64) in ischaemic stroke patients without diabetes, but not significantly increased in patients with diabetes [22].…”

Section: Stroke-associated Hyperglycaemiamentioning

confidence: 99%

Management of blood glucose in patients with stroke

Radermecker

Scheen

2010

Diabetes & Metabolism

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SUMMARYStroke is a leading cause of death worldwide and the commonest cause of long-term disability amongst adults, more particularly in patients with diabetes mellitus and arterial hypertension.Increasing evidence suggests that disordered physiological variables following acute ischaemic stroke, especially hyperglycaemia, adversely affect outcomes. Post-stroke hyperglycaemia is common (up to 50 % of patients) and may be rather prolonged, regardless of diabetes status. A substantial body of evidence has demonstrated that hyperglycaemia has a deleterious effect upon clinical and morphological stroke outcomes. Therefore, hyperglycaemia represents an attractive physiological target for acute stroke therapies.However, whether intensive glycaemic manipulation positively influences the fate of ischaemic tissue remains unknown. One major adverse event of management of hyperglycaemia with insulin (either glucose-potassium-insulin infusions or intensive insulin therapy) is the occurrence of hypoglycaemia, which can also induce cerebral damages. Novel insights into post-stroke hyperglycaemia management are derived from continuous glucose monitoring systems (CGMS). This article aims to describe the adverse effects of hyperglycaemia following acute ischaemic stroke and the risk associated to iatrogenic hypoglycaemia, to summarise the evidence from current glucose-lowering treatment trials and to show the usefulness of CGMS in both nondiabetic and diabetic patients with acute stroke. Key-words Mots-clé :Accident vasculaire cérébral -Diabète -Hyperglycémie -Hypoglycémie - Insulinothérapie -CGMS

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Section: Stroke-associated Hyperglycaemiamentioning

confidence: 99%

Management of blood glucose in patients with stroke

Radermecker

Scheen

2010

Diabetes & Metabolism

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“…1,2,5,8,[14][15][16][18][19][20][31][32][33][34][35][36] Our team and others have previously demonstrated the association between malglycemia (hyperglycemia, hypoglycemia and increased glycemic variability) and increased NRM and infections in HCT patients. [24][25][26] In addition, adverse clinical consequences of hyperglycemia from total parenteral nutrition exposure during HCT were reported.…”

Section: Discussionmentioning

confidence: 99%

Blood glucose control using a computer-guided glucose management system in allogeneic hematopoietic cell transplant recipients

Espina

Jenkins

Taylor

et al. 2016

Bone Marrow Transplant

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Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative treatment for patients with hematological malignancies. However, is associated with substantial rates of morbidity and mortality. We and others have shown that malglycemia is associated with adverse transplant outcome. Therefore, improving glycemic control may improve transplant outcome. In this prospective study we evaluated the feasibility of using Glucommander (a Computer-Guided Glucose Management System; CGGM) in order to achieve improved glucose control in hospitalized HCT patients. Nineteen adult patients contributed 21 separate instances on CGGM. Patients were on CGGM for a median of 43 h. Median initial blood glucose (BG) on CGGM was 244 mg/dL, and patients on 20 study instances reached the study BG target of 100-140 mg/dL after a median of 6 h. After BG reached the target range, the median average BG level per patient was 124 mg/dL. Six patients had a total of 10 events of BG o 70 mg/dL (0.9% of BG measurements), and no patients experienced BG level o 40 mg/dL. The total estimated duration of BG o 70 mg/dL was 3 h (0.2% of the total CGGM time). In conclusion, our study demonstrates that stringent BG control in HCT patients using CGGM is feasible.

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“…Indeed, admission hyperglycemia has been linked to poor clinical outcomes in hospitalized patients for a variety of conditions, particularly for myocardial infarction, stroke, and critical illness. [12][13][14][15] In this study, we evaluated recognition, communication, and management of ED glucose values above a relatively conservative threshold of 140 mg/dL, occurring in 21% of ED glucose results. Diabetes screening thresholds for casual glucose values as low as 120 mg/dL, 9 and intensive glycemic control in critically ill patients to a target as low as 110 mg/dL have been suggested.…”

Section: Discussionmentioning

confidence: 99%

Limited communication and management of emergency department hyperglycemia in hospitalized patients

Ginde

Savaser

Camargo

2009

Journal of Hospital Medicine

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BACKGROUND:Hyperglycemia is often overlooked and unaddressed in hospitalized patients, and early and intensive management may improve outcomes.OBJECTIVE:To evaluate communication and early management of emergency department (ED) hyperglycemia.METHODS:This was a retrospective cohort study of patients with an initial serum glucose ≥140 mg/dL at an urban, academic institution. We randomly selected cases from a consecutive sample of ED visits with at least 1 serum glucose result during a 1‐year period. We recorded clinical data and compared the content of inpatient and ED‐written discharge instructions.RESULTS:Of the 27,688 initial ED glucose results during the study period, 3517 (13%) were 140‐199 mg/dL, and 2304 (8%) values were ≥200 mg/dL. In our sample of 385 patients, 293 (76%) patients were hospitalized. Inpatient or ED discharge instructions informed 36 (10%) patients of their hyperglycemia and 23 (6%) of a plan for further evaluation and management. There was no difference between inpatient and ED instructions for either of these variables (P = 0.73 and 0.16, respectively). Overall, 107 (55%) patients with glucose values 140‐199 mg/dL and 31 (16%) patients with glucose ≥200 mg/dL had no prior diabetes diagnosis. Only 61 (16%) received insulin in the ED for their hyperglycemia, and hyperglycemia was charted as a diagnosis in 36 (9%) cases.CONCLUSIONS:Most ED patients with even mild hyperglycemia were hospitalized. Recognition, communication, and management of ED hyperglycemia were suboptimal and represent a missed opportunity to identify undiagnosed diabetes and to initiate early glycemic control for hospitalized patients. Journal of Hospital Medicine 2009;4:45–49. © 2009 Society of Hospital Medicine.

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Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke

Cited by 396 publications

References 31 publications

Management of blood glucose in patients with stroke

Management of blood glucose in patients with stroke

Blood glucose control using a computer-guided glucose management system in allogeneic hematopoietic cell transplant recipients

Limited communication and management of emergency department hyperglycemia in hospitalized patients

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