Natural history of blood glucose within the first 48 hours after ischemic stroke

Abstract

Background: Despite suggestions that glucose levels rise after stroke before falling within a few hours, the natural history and determinants of this phenomenon remain unclear. We aimed to better characterise the time course of changes in glucose levels after ischemic stroke and to identify factors that affect post-stroke glycemia. Methods: Ischemic stroke patients without previously diagnosed diabetes had blood glucose measured at least 4-hourly until 48 hours post-stroke. The relationship between baseline factors, such as the NIHSS, and blood glucose was assessed with mixed-effect models. The behaviour of glucose over time was modelled in the whole cohort, and for the cohort partitioned into two around an admission glucose of 6.0 mmol/L. Results: In the cohort of 124 patients the mean glucose was 5.7 mmol/L throughout the period of monitoring, with no change over time. Mixed-effects models identified more severe stroke and glucose-lowering therapy to be associated with higher post-stroke glucose levels. When the cohort was partitioned, the mean glucose of those below 6.0 mmol/L at admission increased and the mean glucose of those above 6.0 mmol/L at admission decreased to the overall mean. Conclusions: Mean glucose levels remain static in ischemic stroke patients without diabetes until at least 48 hours post-stroke. Serial glucose levels are higher in patients with more severe stroke. Initially high or low mean glucose recordings exhibit regression to the mean over time, a change which may merely be a statistical phenomenon without necessarily indicating resolution of abnormal glycemia. Background: The role of elevated blood pressure (BP) in determining prognosis after spontaneous intracerebral haemorrhage (ICH) is highly controversial , with arguments both for and against early BP lowering. Aims: We undertook an exploratory preliminary analysis of blinded data in the vanguard (initial) phase of the INTERACT study, an open label, multi-centre, randomised controlled trial of early intensive BP lowering in 404 patients with ICH. Our aim was to determine the role of initial BP and other baseline factors associated with early haematoma growth. Methods: Complete data were available in 280 patients with baseline (<6 hours) and 24 hour follow-up CT in order to develop a logistic regression model that included various potential baseline variables as predictors of 'significant' (>33% of total ICH volume) haematoma growth. Age, sex and time to presentation were included in the model as potential confounders. Results: Baseline systolic BP was significantly associated with haematoma growth (higher systolic BP with increased growth). The odds of increased growth with a 10 mmHg increase in systolic BP were 1.27 (P < 0.05). Other significant predictors included high NIHSS scores (high scores with increased growth), time from onset to baseline CT (early baseline CT with increased growth), haematoma volume (smaller volumes with increased growth) and oedema volume (larger volumes with increased growth). Conclusion: We report, f...

Subjecting Acute Ischemic Stroke Patients to Continuous Tube Feeding and an Intensive Computerized Protocol Establishes Tight Glycemic Control

“…However, all patient groups were treated on the same stroke units and standard stroke care was maintained in the period that separated the inclusion periods, minimizing a possible time effect. Moreover, the inclusion of more severe strokes in the continuously fed intensive group probably does not debilitate our results, as achieving TGC is presumed to be more difficult in a more severe stroke [27,41].…”

Higher Blood Glucose within the Normal Range Is Associated with More Severe Strokes

“…As blood glucose was measured at a time when the stress-induced BG increase [12, 19–21, 23] is known to have resolved [7, 23, 24], our study points to a graded association between higher glucose concentrations and more severe stroke-induced brain injury. …”

“…However, within a week at least, BG again declines and reaches a stable level [19–22]. Most studies point to an association between initial stroke severity and hyperglycemia on admission to hospital [7, 23, 24], but there are no studies on the association between stroke severity and BG concentrations within the normoglycemic range. Available studies have hitherto used blood samples drawn in the hours after stroke when BG is elevated and therefore do not directly reflect BG concentration at the time of the stroke event [7, 23, 24].…”

“…Most studies point to an association between initial stroke severity and hyperglycemia on admission to hospital [7, 23, 24], but there are no studies on the association between stroke severity and BG concentrations within the normoglycemic range. Available studies have hitherto used blood samples drawn in the hours after stroke when BG is elevated and therefore do not directly reflect BG concentration at the time of the stroke event [7, 23, 24]. On the premise that FBG measured about one week after stroke (when the stress response has resolved) [22] is representative of the patient's habitual BG at the time of the stroke we studied the association of stroke severity and FBG measured about one week after stroke, in a cohort of 361 nondiabetic stroke patients with FBG within the normoglycemic range 70–130 mg/dL [25].…”

Diabetes and stroke

“…Hyperglycemia in the acute stroke period has been associated with an adverse outcome [34], perhaps because a large stroke can provoke hyperglycemia [35]. This was confi rmed last year in an analysis of 748 participants enrolled in the European Cooperative Acute Stroke Study (ECASS)-II trial.…”