Persistent Hyperglycemia &gt;155 mg/dL in Acute Ischemic Stroke Patients: How Well Are We Correcting It?

Fuentes, Blanca; Ortega-Casarrubios, M A; San-José, B.; Castillo, José; Leira, Rogelio; Serena, Joaquı́n; Vivancos, José; Dávalos, Antonio; Gil‐Núñez, A.; Egido, J.; Díez‐Tejedor, Exuperio

doi:10.1161/strokeaha.110.591529

Cited by 46 publications

(37 citation statements)

References 7 publications

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“…In the present study, we did not consider the possibility that diabetic patients could have had persistent poststroke hyperglycemia during the first days after onset, which could have an influence on stroke outcome, as has been demonstrated in a recently published study. 33 Moreover, we performed the analysis based on a "yes or no diagnosis" of DM at admission or during hospitalization and did not collect information on new cases of DM at 3 and 6 months after stroke onset. Consequently, we could not analyze its impact on the final results.…”

Section: Discussionmentioning

confidence: 99%

Diabetes and Poor Outcomes Within 6 Months After Acute Ischemic Stroke

Jia

Zhao

Wang

et al. 2011

Stroke

143

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Background and Purpose-Diabetes mellitus (DM) is an independent risk factor for ischemic stroke. However, controversy exists with regard to the impact of DM on prognosis after ischemic stroke in the Chinese population. We investigated the associations between DM and death, dependency, and stroke recurrence in patients after ischemic stroke onset in a nationwide, prospective registry, the China National Stroke Registry. Methods-The China National Stroke Registry consecutively recruited patients hospitalized for acute ischemic stroke in 2007 to 2008 and who were prospectively followed up for clinical and functional outcomes (death, dependency, and stroke recurrence) at 3 and 6 months after disease onset. Multivariable logistic regression was performed to analyze the association between DM and stroke outcomes after adjusting for potential confounding including age, sex, National Institutes of Health Stroke Scale score, glucose level at admission, hypertension, coronary heart disease, smoking, urinary tract infection, and other factors. Results-DM was identified in 3483 (27.0%) of stroke patients. Compared with stroke patients without DM, patients with DM had a significantly higher incidence of death or dependency and of recurrent stroke at 3 and 6 months after stroke onset. DM was an independent risk factor for death or dependency (adjusted odds ratioϭ1.23; 95% confidence interval, 1.10 to 1.37) in patients with ischemic stroke at 6 months after onset. Conclusions-DM independently predicted poor outcomes in Chinese patients after acute ischemic stroke. (Stroke. 2011; 42:2758-2762.)

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Section: Discussionmentioning

confidence: 99%

Diabetes and Poor Outcomes Within 6 Months After Acute Ischemic Stroke

Jia

Zhao

Wang

et al. 2011

Stroke

143

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“…[3][4][5][6] Persistent hyperglycemia in the postischemic period is an independent predictor of worse neurologic outcome and 90-day mortality. 7,8 Preexisting hyperglycemia also increases the ischemic brain infarct in numerous animal models, as recently reviewed. 9 Etiology of hyperglycemia, whether by insulin resistance, impaired insulin secretion, or exogenous glucose challenge, does not seem to be a deciding factor.…”

Section: Introductionmentioning

confidence: 99%

Role of Soluble Epoxide Hydrolase in Exacerbation of Stroke by Streptozotocin-Induced Type 1 Diabetes Mellitus

Jouihan

Zuloaga

Zhang

et al. 2013

J Cereb Blood Flow Metab

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Hyperglycemia worsens stroke, yet rigorous glycemic control does not improve neurologic outcome. An alternative is to target downstream molecular mediator(s) triggered by hyperglycemia but independent of prevailing glycemia. Soluble epoxide hydrolase (sEH) is a potential mediator of injury via its metabolism of neuroprotective epoxyeicosatrienoic acids (EETs). We tested whether hyperglycemia exacerbates cerebral injury by upregulating sEH and decreasing brain EET levels. Type 1 diabetes mellitus was modeled by streptozotocin (STZ; 50 mg/kg per day intraperitoneally, 5 days) in male mice. At 4 weeks, STZ-treated and control mice underwent 45-minute middle cerebral artery occlusion (MCAO) with or without sEH blockade by trans-4-[4-(3-adamantan-1-ylureido)-cyclohexyloxy]-benzoic acid (t-AUCB; 1 mg/kg intraperitoneally daily for 6 days before MCAO). The STZ-treated mice had increased sEH mRNA expression in cerebral vessels and decreased EET concentrations in brain. There was no difference in cortical perfusion between groups. The STZ-treated mice sustained larger brain infarct than controls. Pretreatment with t-AUCB eliminated the difference in infarct size and EETs concentration between STZ-treated mice and controls, without altering glycemia. We conclude that type 1 diabetes mellitus upregulates sEH mRNA and decreases concentrations of neuroprotective EETs within the brain, leading to worse stroke outcome. The data indicate that sEH antagonism may be beneficial in the setting of hyperglycemic stroke.

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“…Moreover, there is incomplete agreement regarding the glucose threshold levels which should trigger insulin administration (10 and 7.7–10.2 mmol/l, respectively) [7,8]. Similarly, studies have used different glucose thresholds to define PSH: recently, Fuentes et al [9] defined PSH as blood glucose ≥155 mg/dl (8.6 mmol/l) because that was the threshold associated with poor outcome in the GLycemia in Acute Stroke (GLIAS) study [10]. On the other hand, previous studies used a lower threshold of 7 mmol/l [11,12].…”

Section: Introductionmentioning

confidence: 99%

Persistent Hyperglycemia at 24–48 h in Acute Hyperglycemic Stroke Patients Is Not Associated with a Worse Functional Outcome

Ntaios¹,

Abatzi²,

Alexandrou³

et al. 2011

Cerebrovasc Dis

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Background: Recently, it was shown that the relation between admission glucose and functional outcome after ischemic stroke is described by a J-shaped curve, with a glucose range of 3.7–7.3 mmol/l associated with a favorable outcome. We tested the hypothesis that persistence of hyperglycemia above this threshold at 24–48 h after stroke onset impairs 3-month functional outcome. Methods: We analyzed all patients with glucose >7.3 mmol/l on admission from the Acute STroke Registry and Analysis of Lausanne (ASTRAL). Patients were divided into two groups according to their subacute glucose level at 24–48 h after last well-being time (group 1: ≤7.3 mmol/l, group 2: >7.3 mmol/l). A favorable functional outcome was defined as a modified Rankin Score (mRS) ≤2 at 3 months. A multiple logistic regression analysis of multiple demographic, clinical, laboratory and neuroimaging covariates was performed to assess predictors of an unfavorable outcome. Results: A total of 1,984 patients with ischemic stroke were admitted between January 1, 2003 and October 20, 2009, within 24 h after last well-being time. In the 421 patients (21.2%) with admission glucose >7.3 mmol/l, the proportion of patients with a favorable outcome was not statistically significantly different between the two groups (59.2 vs. 48.7%, respectively). In multiple logistic regression analysis, unfavorable outcome was significantly associated with age (odds ratio, OR: 1.06, 95% confidence interval, 95% CI: 1.03–1.08 for every 10-year increase), National Institute of Health Stroke Score, NIHSS score, on admission (OR: 1.16, 95% CI: 1.11–1.21), prehospital mRS (OR: 12.63, 95% CI: 2.61–61.10 for patients with score >0), antidiabetic drug usage (OR: 0.36, 95% CI: 0.15–0.86) and glucose on admission (OR: 1.16, 95% CI: 1.02–1.31 for every 1 mmol/l increase). No association was found between persistent hyperglycemia at 24–28 h and outcome in either diabetics or nondiabetics. Conclusions: In ischemic stroke patients with acute hyperglycemia, persistent hyperglycemia (>7.3 mmol/l) at 24–48 h after stroke onset is not associated with a worse functional outcome at 3 months whether the patient was previously diabetic or not.

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Persistent Hyperglycemia >155 mg/dL in Acute Ischemic Stroke Patients: How Well Are We Correcting It?

Cited by 46 publications

References 7 publications

Diabetes and Poor Outcomes Within 6 Months After Acute Ischemic Stroke

Diabetes and Poor Outcomes Within 6 Months After Acute Ischemic Stroke

Role of Soluble Epoxide Hydrolase in Exacerbation of Stroke by Streptozotocin-Induced Type 1 Diabetes Mellitus

Persistent Hyperglycemia at 24–48 h in Acute Hyperglycemic Stroke Patients Is Not Associated with a Worse Functional Outcome

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