Blood Glucose and Prognosis of Acute Stroke

Abstract

To study the relation of blood glucose soon after the onset of stroke and outcome in terms of fatality and functional recovery 6 months later, two prospective studies were performed. Fasting blood glucose measured within 48 hours of onset was significantly higher in those who died than in those who survived. However, random blood glucose, mean daily blood glucose and HbA1 were not related to fatality or functional recovery. Fasting blood glucose levels soon after the stroke were significantly higher than those in the same patients measured 1 month later. These results suggest that the hyperglycaemia related to decreased survival is a stress response rather than an indication of preexisting diabetes mellitus but do not support the view that a high blood glucose level is itself harmful to the brain.

Stress hormone and blood glucose response following acute stroke in the elderly.

“…11 The use of a random versus fasting blood sugar concentration also appears to influence the results. 12 We found a clear difference in the fasting glucose levels between the good and poor outcome groups that persisted for up to 1 month, confirming the findings of Pulsinelli et al 1 and others. 2 The large proportion of our patients who had either died or were severely disabled at 6 months is consistent with the known consequences of stroke in an elderly population.…”

“…It might be due to the unmasking of a premorbid abnormal glucose tolerance. 14 - 15 Power et al 12 argued, however, that the relation between outcome and the fasting, rather than the random, blood sugar concentration pointed toward the hyperglycemia being a function of a stress response and not of preexisting glucose intolerance. In a large study, Woo et al 16 found a greater relation between outcome and stress hyperglycemia in nondiabetics than in known or newly diagnosed diabetics.…”

Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients

“…21 Thirty-one articles describing 32 cohort studies (1 article described 2 separate cohorts 22 ) therefore were included in the overview. 1,[7][8][9][10][11][12] …”

“…The assessment was based on a validated scale (Barthel Index, 10,23,45 Glasgow Outcome Scale, 37,45 Canadian Stroke Scale, 24 and Canadian Neurological Scale 25 ) in 6 of these studies. The remainder used the following qualitative descriptions of poor functional recovery: unable to return to any form of work, 7 persistent disability, 26 need for residential placement, 27 dependent in activities of daily living, 11,22,28 and stable deficit with no recovery. 29 Diabetes status was assigned on the basis of a history of diabetes or treatment with hypoglycemic agents in 20 of 32 studies ‡; in 8 studies, an elevated glycosylated hemoglobin 8,12,23,32,35,37 or persistent or marked hyperglycemia 10,25 was used to define diabetes.…”

“…Table 2 shows the unadjusted relative risk of poor functional recovery associated with stress hyperglycemia, which could be calculated from data in 8 studies. 7,22,23,[25][26][27]29,37 Stress hyperglycemia on admission was associated with poor functional recovery up to 6 months after stroke in nondiabetic patients (pooled unadjusted relative risk of poor functional recoveryϭ1.41; 95% CI, 1.16 to 1.73). Data on stroke recovery in diabetic patients were not reported.…”