Persistent Poststroke Hyperglycemia Is Independently Associated With Infarct Expansion and Worse Clinical Outcome

Baird, Tracey; Phan, Thanh G.; Butcher, Ken; Desmond, Patricia; Tress, Brian M.; Colman, Peter G; Chambers, Brian R.; Davis, Stephen M.

doi:10.1161/01.str.0000085087.41330.ff

Cited by 555 publications

(403 citation statements)

References 59 publications

(47 reference statements)

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“…The CGM device has recently been used to examine the detailed dynamic state in diabetic patients with simple and safe installation. Baird et al1 examined blood glucose levels using the CGM in 25 patients with anterior circulation stroke syndrome; only mean blood glucose level was measured as a glucose parameter to examine its relationship to poor outcomes. Ribo et al22 showed that the longer duration of blood glucose ≥140 mg/dL on the CGM and the longer time to middle cerebral artery recanalization after intravenous thrombolysis were related to unfavorable outcomes at 3 months in 47 ischemic stroke patients.…”

Section: Discussionmentioning

confidence: 99%

“…Elevation of blood glucose levels caused activation of the coagulant system, suppression of the fibrinolytic system, and production of free radicals 26, 28, 29, 30, 31. This elevation may also lead to acidosis, excitatory amino acids, and injury to the blood–brain barrier, which cause ischemic brain damage in animal models and expand ischemic lesions volumetrically 1, 23, 25, 32. Expanding lesions may lead to production of cortisol and norepinephrine, which worsen hyperglycemia.…”

Section: Discussionmentioning

confidence: 99%

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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%

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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“…Using this technology, Baird et al performed a pilot study in which they aimed to directly address the relationship between stroke outcome and contemporaneous glycaemia [37]. This trial enrolled 25 subjects within 24 hours of ischaemic stroke symptoms.…”

Section: Lessons From Continuous Glucose Monitoringmentioning

confidence: 99%

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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“…This relation is now known to be independent of other predictors of poor clinical outcome, such as stroke severity score, infarct size, age, or having diabetes [36]. In the Glycemia in Acute Stroke (GLIAS) trial [37], it was found that an elevated glucose of more than 155 mg/dL in the first 48 hours after an acute ischemic stroke was associated with a 2.7-fold increase in poor functional outcome, and there was a 3-fold increase in the risk of death at 3 months [37].…”

Section: Hyperglycemia In the Stroke Patientmentioning

confidence: 98%

Care of the Stroke Patient: Routine Management to Lifesaving Treatment Options

2011

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The management of the acute ischemic stroke patient spans the time course from the emergency evaluation and treatment period through to the eventual discharge planning phase of stroke care. In this article we evaluate the literature and describe what have become standard treatments in the care of the stroke patient. We will review the literature that supports the use of a dedicated stroke unit for routine stroke care which has demonstrated reduced rates of morbidity and mortality. Also reviewed is the use of glycemic control in the initial setting along with data supporting the use of prophylactic treatments options in order to aide in the prevention of life threatening medical complications. In addition, lifesaving treatments will be discussed in light of new literature demonstrating reduced mortality in large hemispheric stroke patients undergoing surgical decompressive surgery. Both medical and surgical treatment options are discussed and compared.

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Persistent Poststroke Hyperglycemia Is Independently Associated With Infarct Expansion and Worse Clinical Outcome

Cited by 555 publications

References 59 publications

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Management of blood glucose in patients with stroke

Care of the Stroke Patient: Routine Management to Lifesaving Treatment Options

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