Frequency and Temporal Profile of Poststroke Hyperglycemia Using Continuous Glucose Monitoring

Abstract

OBJECTIVE -Poststroke hyperglycemia (PSH) is common and has adverse effects on outcome. In this observational study, we aimed to describe the frequency and temporal profile of PSH using a continuous glucose monitoring system (CGMS) in patients with and without diabetes.RESEARCH DESIGN AND METHODS -Fifty-nine patients with acute hemispheric ischemic stroke were prospectively studied with the CGMS, regardless of medication, admission plasma glucose value, and diabetes status. The CGMS records interstitial glucose every 5 min for 72 h.RESULTS -On admission, 36% of patients had preexisting diabetes. At the earliest analyzed time point of 8 h from stroke onset, 50% of nondiabetic subjects and 100% of diabetic patients were hyperglycemic (Ն7 mmol/l). This early-phase hyperglycemia was followed by a decrease in glucose 14 -16 h poststroke when only 11% of nondiabetic and 27% of diabetic patients were hyperglycemic. A late hyperglycemic phase 48 -88 h poststroke was observed in 27% of nondiabetic and 78% of diabetic patients. Thirty-four percent of nondiabetic and 86% of diabetic patients were hyperglycemic for at least a quarter of the monitoring period. Multivariate regression analysis demonstrated that diabetes, insular cortical ischemia, and increasing age independently predicted higher glucose values.CONCLUSIONS -Poststroke hyperglycemia is common and prolonged despite treatment based on current guidelines. There are early and late hyperglycemic phases in nondiabetic as well as diabetic patients. Treatment protocols with frequent glucose measurement and intensive glucose-lowering therapy for a minimum of 72 h poststroke need to be evaluated.

The Prognostic Value of Capillary Glucose Levels in Acute Stroke

“…Thus, it has been shown that poststroke hyperglycemia is common and prolonged despite current guidelines-based treatment, and 2 hyperglycemic phases were identified: an early hyperglycemia phase within the first 8 hours affecting up to 50% of nondiabetic and 100% of patients with diabetes and a later phase 48 to 88 hours poststroke that affects 27% of nondiabetic and 78% of diabetic subjects. 17 We have also found that patients with diabetes had higher glucose levels within the first 48 hours than patients without diabetes, but no significant differences in outcome between patients with diabetes and those without diabetes with hyperglycemia were found, suggesting that outcome is more related to the development of hyperglycemia Ն155 mg/dL than to the diagnosis of diabetes.…”

Management of blood glucose in patients with stroke

“…The conclusion was that there is an urgent need to study normalization of blood glucose after stroke. Later on, Allport et al [38] used CGMS device in 59 patients with acute hemispheric ischaemic stroke.…”

J-Shaped Association Between Serum Glucose and Functional Outcome in Acute Ischemic Stroke

“…1 The incidence of poststroke hyperglycemia is estimated at 45% in studies with frequent glucose measurements and a threshold value of 7 mmol/L to define hyperglycemia. 2 Because the prevalence of previously diagnosed diabetes mellitus in stroke patients is estimated between 10% and 20%, diabetes mellitus is obviously not the only underlying pathophysiologic mechanism of poststroke hyperglycemia. 3 Previously undiagnosed diabetes mellitus and impaired glucose tolerance account for a further 5% to 28%.…”