Persistent hyperglycemia is a useful glycemic pattern to predict stroke mortality: a systematic review and meta-analysis

Hou, Duanlu; Zhong, Ping; Ye, Xiaofei; Wu, Danhong

doi:10.1186/s12883-021-02512-1

Cited by 8 publications

(10 citation statements)

References 40 publications

(57 reference statements)

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“…First, the influence of elevated BG has not been fully elucidated. Previous literature has examined the impact of hyperglycemia on poor prognosis in different critically ill patients, such as those with myocardial infarction (7), acute pancreatitis (8), and stroke (9). However, these connections are not consistent across sepsis patients.…”

Section: Introductionmentioning

confidence: 99%

Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization

Gan

Sun

et al. 2022

Front. Public Health

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BackgroundThere was considerable debate regarding the effect of mean blood glucose (MBG) and glycemic variability (GV) on the mortality of septic patients. This retrospective cohort study aimed to assess the association between MBG and GV with ICU mortality of sepsis patients and to explore the optimal MBG range.MethodsSepsis patients were enrolled from the Medical Information Mart for Intensive Care IV database (MIMIC-IV). MBG and glycemic coefficient of variation (GluCV) were, respectively, calculated to represent the overall glycemic status and GV during ICU stay. The associations between MBG, GluCV, and ICU mortality of the septic patients were assessed by using multivariate logistic regression in different subgroups and the severity of sepsis. Restricted cubic splines evaluated the optimal MBG target.ResultsA total of 7,104 adult sepsis patients were included. The multivariate logistic regression results showed that increased MBG and GluCV were significantly correlated with ICU mortality. The adjusted odds ratios were 1.14 (95% CI 1.09–1.20) and 1.05 (95% CI 1.00–1.12). However, there was no association between hyperglycemia and ICU mortality among diabetes, liver disease, immunosuppression, and hypoglycemia patients. And the impact of high GluCV on ICU mortality was not observed in those with diabetes, immunosuppression, liver disease, and non-septic shock. The ICU mortality risk of severe hyperglycemia (≧200 mg/dl) and high GluCV (>31.429%), respectively, elevated 2.30, 3.15, 3.06, and 2.37, 2.79, 3.14-folds in mild (SOFA ≦ 3), middle (SOFA 3–7), and severe group (SOFA ≧ 7). The MBG level was associated with the lowest risk of ICU mortality and hypoglycemia between 120 and 140 mg/dl in the subgroup without diabetes. For the diabetic subset, the incidence of hypoglycemia was significantly reduced when the MBG was 140–190 mg/dl, but a glycemic control target effectively reducing ICU mortality was not observed.ConclusionMBG and GluCV during the ICU stay were associated with all-cause ICU mortality in sepsis patients; however, their harms are not apparent in some particular subgroups. The impact of hyperglycemia and high GV on death increased with the severity of sepsis. The risk of ICU mortality and hypoglycemia in those with no pre-existing diabetes was lower when maintaining the MBG in the range of 120–140 mg/dl.

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Section: Introductionmentioning

confidence: 99%

Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization

Gan

Sun

et al. 2022

Front. Public Health

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“…Hyperglycaemia is present in 30-40% of people with acute ischaemic stroke, even without a history of diabetes (7,9). However, randomized clinical trials failed to show a bene t from intensive glucose control acutely (up to 72 hours) after stroke (12).…”

Section: Discussionmentioning

confidence: 99%

“…Hyperglycaemia is one of the hallmarks of T2D. In stroke patients (with or without diabetes), hyperglycaemia at admission is associated with poor outcome (9)(10)(11) and to date, interventional studies have been mainly focused on controlling hyperglycaemia acutely after hospitalization. However, the results of these studies showed no clinical bene t (12) suggesting that other underlying pathophysiological mechanisms of diabetes may be responsible of poor stroke recovery.…”

Section: Introductionmentioning

confidence: 99%

The pre-stroke induction and normalization of insulin resistance respectively worsens and improves functional recovery

Vercalsteren

Karampatsi

Dekens³

et al. 2022

Preprint

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Background Type 2 diabetes (T2D) impairs post-stroke functional recovery, and the underlying mechanisms are mostly unknown. Insulin resistance (IR), which is a hallmark of T2D, also afflicts up to 50% of the elderly without T2D. IR has been associated with impaired recovery after stroke. However, the causative role of IR in impaired stroke recovery has not been demonstrated. By using different mouse models of early IR, we investigated the potential crosstalk between IR and stroke recovery as well as some of the cellular mechanisms possibly involved. Methods We used three different models of IR. Early IR with or without fasting hyperglycaemia was respectively induced by 4 months of high fat diet or by 30% sucrose supplementation in the drinking water. In addition, we used 10-month-old mice that spontaneously develop IR, but not hyperglycaemia, and where IR was targeted pharmacologically pre-stroke with 10 mg/kg/day Rosiglitazone. Stroke was induced by transient middle cerebral artery occlusion and post-stroke recovery was assessed by sensorimotor tests. Neuronal survival, neuroinflammation and neuroplasticity mediated by cholinergic interneurons were assessed by immunohistochemistry/quantitative microscopy. Results The induction of IR before stroke, with or without hyperglycaemia, impaired post-stroke neurological recovery. Moreover, the results indicate the involvement of increased neuroinflammation and decreased cholinergic interneuron-mediated neuroplasticity in the recorded effects. Importantly, the pharmacological normalization of IR, significantly improved post-stroke neurological recovery. Conclusion The global diabetes epidemic and world population aging are dramatically increasing the percentage of people in need of post-stroke treatment and care. Targeting hyperglycaemia acutely post-stroke has so far provided negative results to improve stroke outcome and new targets are highly needed. The results of our study suggest that future clinical studies should focus on the specific targeting of pre-stroke IR to reduce the sequelaeof stroke in both diabetic patients and the elderly suffering from prediabetes.

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“…Hyperglycemia is one of the hallmarks of T2D. In stroke patients (with or without diabetes), hyperglycemia at admission is associated with a poor outcome [ 9 , 10 , 11 ] and, to date, interventional studies have been mainly focused on controlling hyperglycemia acutely after hospitalization. However, the benefit of treating hyperglycemia after stroke remains elusive, and intensive glucose control has shown no additional clinical benefit compared to standard in-hospital glycemic control [ 12 ], suggesting that other underlying pathophysiological mechanisms of diabetes may be responsible for poor stroke recovery.…”

Section: Introductionmentioning

confidence: 99%

The Pre-Stroke Induction and Normalization of Insulin Resistance Respectively Worsens and Improves Functional Recovery

Vercalsteren

Karampatsi

Dekens

et al. 2023

IJMS

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Type 2 diabetes (T2D) impairs post-stroke recovery, and the underlying mechanisms are unknown. Insulin resistance (IR), a T2D hallmark that is also closely linked to aging, has been associated with impaired post-stroke recovery. However, whether IR worsens stroke recovery is unknown. We addressed this question in mouse models where early IR, with or without hyperglycemia, was induced by chronic high-fat diet feeding or sucrose supplementation in the drinking water, respectively. Furthermore, we used 10-month-old mice, spontaneously developing IR but not hyperglycemia, where IR was normalized pharmacologically pre-stroke with Rosiglitazone. Stroke was induced by transient middle cerebral artery occlusion and recovery was assessed by sensorimotor tests. Neuronal survival, neuroinflammation and the density of striatal cholinergic interneurons were also assessed by immunohistochemistry/quantitative microscopy. Pre-stroke induction and normalization of IR, respectively, worsened and improved post-stroke neurological recovery. Moreover, our data indicate a potential association of this impaired recovery with exacerbated neuroinflammation and a decreased density of striatal cholinergic interneurons. The global diabetes epidemic and population aging are dramatically increasing the percentage of people in need of post-stroke treatment/care. Our results suggest that future clinical studies should target pre-stroke IR to reduce stroke sequelae in both diabetics and elderly people with prediabetes.

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Persistent hyperglycemia is a useful glycemic pattern to predict stroke mortality: a systematic review and meta-analysis

Cited by 8 publications

References 40 publications

Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization

Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization

The pre-stroke induction and normalization of insulin resistance respectively worsens and improves functional recovery

The Pre-Stroke Induction and Normalization of Insulin Resistance Respectively Worsens and Improves Functional Recovery

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