Acute Glycemic Variability and Functional Outcome in Patients with Acute Ischemic Stroke: A Meta-Analysis

Abstract

Dysglycemia are involved in the development of functional impairment after acute ischemic stroke (AIS). The aim of the study was to evaluate the association between acute glycemic variability and functional outcome in patients with AIS. Cohort studies were obtained by search Medline, Web of Science, Embase, Wanfang, and China National Knowledge Infrastructure databases from inception to November, 2021. A random-effect model which incorporates the intra-study heterogeneity was chosen to pool the results. Ten cohort studies including 3038 patients were included, and 1319 (43.4%) had poor functional outcome (modified Rankin Scale >2) up to three months after disease onset. Pooled results showed that higher acute GV was associated with an increased risk of poor functional outcome, as evidenced by GV evaluated by the standard deviation of blood glucose (SDBG, OR: 1.91, 95% CI: 1.38 to 2.65, I2=60%, p<0.001), the coefficient of variation of blood glucose (OR: 2.03, 95% CI: 1.15 to 3.58, I2=17%, p=0.02), the range of glucose (OR: 1.43, 95% CI: 1.11 to 1.83, I2=22%, p=0.005), and the mean amplitude of glycemic excursion (OR: 1.59, 95% CI: 1.10 to 2.31, I2=0%, p=0.01). Subgroup analyses did not support that difference in study design, treatments for AIS, mean age of the patients, duration for GV measuring, or study quality would significantly affect the association between SDBG and functional outcome after AIS. In conclusion, higher acute glycemic variability may predict poor functional outcome within 3 months after AIS.

Glycemic Variability and Prognosis of Patients with Intracerebral Hemorrhage: A Meta-Analysis

“…To the best of our knowledge, this study may be the first meta-analysis, which summarized the relationship between acute GV and prognosis of patients with ICH. Although two recent meta-analyses have showed that increased acute GV in patients with acute stroke is associated with poor functional outcome [13] and increased mortality risk [14], patients included in these studies were predominantly with acute ischemic stroke (AIS), and it remains unknown whether the association remains in patients with ICH. Understanding the role of acute GV in patients with ICH is essential because the pathogenesis and clinical course are different between ICH and AIS.…”

“…Unlike the indices for mean blood glucose level, GV focuses on the extent of glucose fluctuation within months to years (chronic GV) or within days (acute GV) [12]. Subsequent studies have linked acute GV to the severity and poor prognosis of various diseases, such as ischemic stroke [13,14], acute coronary syndrome [15], and sepsis [16]. Although GV is important clinically, its optimum method of characterization remains unclear.…”