Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients

Capes, Sarah E.; Hunt, Dereck; Malmberg, Klas; Pathak, Parbeen; Gerstein, Hertzel C.

doi:10.1161/hs1001.096194

Cited by 1,586 publications

(1,337 citation statements)

References 68 publications

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“…Hyperglycemia in the acute stroke phase is a manifestation of relative insulin deficiency, which is related to increased lipolysis 24. Patients with these factors tend to have hyperglycemia in the acute stroke phase regardless of the presence of diabetes mellitus 26, 27…”

Section: Discussionmentioning

confidence: 99%

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Wada

Yoshimura

Inoue

et al. 2018

JAHA

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BackgroundThe purpose of this study was to examine the relationships between glucose parameters obtained by continuous glucose monitoring and clinical outcomes in acute stroke patients.Methods and ResultsConsecutive patients with acute ischemic stroke or intracerebral hemorrhage within 24 hours after onset were included. A continuous glucose monitoring device (iPro2) was attached for the initial 72 hours after emergent admission. Eight glucose parameters were obtained from continuous glucose monitoring: maximum, minimum, mean, and SD of blood glucose levels, as well as area under the curve more than 8 mmol/L of blood glucose, distribution time more than 8 mmol/L of blood glucose, coefficient of variation (%CV), and presence of time less than 4 mmol/L over 72 hours. The primary outcome measure was death or dependency at 3 months (modified Rankin Scale score ≥3). One hundred patients with acute ischemic stroke (n=58) or intracerebral hemorrhage (n=42) were included. Blood glucose levels varied between 5.2±1.4 and 11.4±3.2 mmol/L over 72 hours, with area under the curve more than 8 mmol/L of blood glucose of 0.7±1.4 min×mmol/L, distribution time more than 8 mmol/L of blood glucose of 31.7±32.7%, coefficient of variation of 15.5±5.4%, and presence of hypoglycemia in 20% of overall patients. Mean glucose level (adjusted odds ratio, 1.60, 95% confidence interval, 1.12–2.28/1 mmol/L), area under the curve more than 8 mmol/L of blood glucose (2.13, 1.12–4.02/1 min×mmol/L), and distribution time more than 8 mmol/L of blood glucose (1.25, 1.05–1.50/10%) were related to death or dependency for overall patients, as well as for acute ischemic stroke patients (2.05, 1.15–3.65; 2.38, 1.04–5.44; 1.85, 1.10–3.10, respectively).ConclusionsHigh mean glucose levels, distribution time more than 8 mmol/L of blood glucose, and areas under the curve more than 8 mmol/L of blood glucose during the initial 72 hours of acute stroke were associated with death or dependency at 3 months.

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Section: Discussionmentioning

confidence: 99%

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Wada

Yoshimura

Inoue

et al. 2018

JAHA

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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]. This observation may suggest that hyperglycaemia per se is a marker of the severity of the stroke rather than a real risk factor.…”

Section: Stroke-associated Hyperglycaemiamentioning

confidence: 96%

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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“…Patients with cardiovascular, infectious, and neurological problems are particularly sensitive to changes in glycemia. [33][34][35][36][37] In critically ill patients, mortality is positively correlated with increasing glucose levels [ 5 mmolÁL -1 , 38 and in patients undergoing cardiovascular procedures, hyperglycemia was associated with increased mortality and organ dysfunction. 39 Patients with fasting glucose levels [ 7 mmolÁL -1 or random blood glucose levels [ 11.1 mmolÁL -1 on general surgical wards had an 18-fold increase in in-hospital mortality, a longer stay, and a greater risk of infection.…”

Section: Glucose Metabolismmentioning

confidence: 99%