Risk of Hyperglycemia and Hypoglycemia in Patients with Acute Ischemic Stroke Based on Continuous Glucose Monitoring

Nukui, Saki; Akiyama, Hisanao; Soga, Kaima; Takao, Naoki; Tsuchihashi, Yoko; Iijima, Noboru; Hasegawa, Yasuhiro

doi:10.1016/j.jstrokecerebrovasdis.2019.104346

Cited by 16 publications

(14 citation statements)

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“…Reports on CGM in acute cerebrovascular diseases showed similar-to-better detection of dysglycaemic events, mainly hypoglycaemia, compared to the standard of care. Interestingly, some of these events show circadian variability and nocturnal preference ( 23 , 24 ), being easily overlooked with the conventional scheduled capillary glucose measurements.…”

Section: Glycaemic Status In Acute Cerebrovascular Illnesses: How To ...mentioning

confidence: 99%

“…Disglycaemia measured by CGM is frequent after acute cerebrovascular events and has been linked to infarct growth in AIS ( 89 , 90 ) and with poor prognosis after AIS and ICH ( 91 ), as shown in Table 2 . It is noteworthy that, in these populations, CGM devices significantly improved hypoglycemia detection compared to standard clinical practice, thus opening a window of opportunity for CGM in patients that require aggressive glycaemic control ( 23 , 24 ). However, to date, intensive glucose lowering in the acute phase of AIS has not reliably proven a clinical benefit, pointing the lack of consensus on hyperglycaemia definition or blood glucose targets ( 92 , 93 ).…”

Section: Diagnostic and Prognostic Yield Of Glucose Monitoring In Acu...mentioning

confidence: 99%

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Clinical relevance of glucose metrics during the early brain injury period after aneurysmal subarachnoid hemorrhage: An opportunity for continuous glucose monitoring

et al. 2022

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Hyperglycaemia, hypoglycaemia and higher glucose variability during the Early Brain Injury (EBI) period of aneurysmal subarachnoid hemorrhage (aSAH) have been associated with poor clinical outcome. However, it is unclear whether these associations are due to direct glucose-driven injury or if hyperglycaemia simply acts as a marker of initial severity. Actually, strict glucose control with intensive insulin therapy has not been demonstrated as an effective strategy for improving clinical outcomes after aSAH. Currently published studies describing an association between hyperglycaemia and prognosis in aSAH patients have been based on isolated glucose measurements and did not incorporate comprehensive dynamic evaluations, such as those derived from subcutaneous continuous glucose monitoring devices (CMG). Arguably, a more accurate knowledge on glycaemic patterns during the acute phase of aSAH could increase our understanding of the relevance of glycaemia as a prognostic factor in this disease as well as to underpin its contribution to secondary focal and diffuse brain injury. Herein, we have summarized the available evidence on the diagnostic and prognostic relevance of glucose metrics during the acute phase of cerebrovascular diseases, focusing in the EBI period after aSAH. Overall, obtaining a more precise scope of acute longitudinal glucose profiles could eventually be useful for improving glucose management protocols in the setting of acute aSAH and to advance toward a more personalized management of aSAH patients during the EBI phase.

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Section: Glycaemic Status In Acute Cerebrovascular Illnesses: How To ...mentioning

confidence: 99%

Section: Diagnostic and Prognostic Yield Of Glucose Monitoring In Acu...mentioning

confidence: 99%

Clinical relevance of glucose metrics during the early brain injury period after aneurysmal subarachnoid hemorrhage: An opportunity for continuous glucose monitoring

et al. 2022

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“…48,49 In the ICU setting, therapy with intravenous insulin infusion allows clinicians to maintain narrow glycemic targets. The panelists reviewed studies using CGMs in the ICU in adult populations (Table 3) 50-83 and pediatric populations (Table 4) 84 -88 .…”

Section: Potential Opportunitiesmentioning

confidence: 99%

Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline

Galindo

Umpiérrez

Rushakoff

et al. 2020

J Diabetes Sci Technol

103

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This article is the work product of the Continuous Glucose Monitor and Automated Insulin Dosing Systems in the Hospital Consensus Guideline Panel, which was organized by Diabetes Technology Society and met virtually on April 23, 2020. The guideline panel consisted of 24 international experts in the use of continuous glucose monitors (CGMs) and automated insulin dosing (AID) systems representing adult endocrinology, pediatric endocrinology, obstetrics and gynecology, advanced practice nursing, diabetes care and education, clinical chemistry, bioengineering, and product liability law. The panelists reviewed the medical literature pertaining to five topics: (1) continuation of home CGMs after hospitalization, (2) initiation of CGMs in the hospital, (3) continuation of AID systems in the hospital, (4) logistics and hands-on care of hospitalized patients using CGMs and AID systems, and (5) data management of CGMs and AID systems in the hospital. The panelists then developed three types of recommendations for each topic, including clinical practice (to use the technology optimally), research (to improve the safety and effectiveness of the technology), and hospital policies (to build an environment for facilitating use of these devices) for each of the five topics. The panelists voted on 78 proposed recommendations. Based on the panel vote, 77 recommendations were classified as either strong or mild. One recommendation failed to reach consensus. Additional research is needed on CGMs and AID systems in the hospital setting regarding device accuracy, practices for deployment, data management, and achievable outcomes. This guideline is intended to support these technologies for the management of hospitalized patients with diabetes.

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“…La terapia intensiva con insulina puede provocar hipoglicemia, la cual se ha asociado a un resultado neurológico pobre. Se recomienda tratar la hiperglicemia con insulina en presencia de cifras séricas de glucosa de 140-185 mg/dL (32) . Se recomienda monitorizar de forma horaria la glucosa en el período transanestésico por las variaciones que puede haber bajo anestesia.…”

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Manejo perioperatorio del paciente neuroquirúrgico COVID-19

Manrique-Carmona¹,

Osorio-Santiago²

2020

Revista Mexicana De Anestesiología

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RESUMEN. La enfermedad provocada por el virus COVID-19 causa el síndrome infeccioso respiratorio agudo severo conocido como SARS-2; este virus puede penetrar el sistema nervioso central y afectar neuronas y células gliales. Clínicamente se manifiesta como encefalitis, ictus isquémico e incluso polineuropatía. Cuando nos enfrentamos a un paciente neuroquirúrgico COVID-19 positivo se requiere una evaluación rápida pero detallada del estado general y neurológico del enfermo. Toda cirugía en presencia de un paciente COVID-19 positivo deberá realizarse con medidas de protección de nivel alto durante la cirugía, el uso de craneotómos y electrocauterios deberá minimizarse, a fin de reducir la producción de aerosol. Los procedimientos transesfenoidales endonasales deben ser evitados durante el período de la pandemia. Nos basamos en el consenso de expertos realizados por la SNACC (Society for Neuroscience in Anesthesiology and Critical Care) para emitir recomendaciones adaptadas a nuestro entorno. La terapia endovascular es una alternativa viable a la trombólisis intravenosa para el reestablecimiento de la circulación. Se ha observado mejor reperfusión en aquellos pacientes que no recibieron sedación o ésta fue ligera, comparado con los pacientes que recibieron anestesia general. En algunos casos no es indispensable la extubación postquirúrgica (especialmente en pacientes infectados con COVID-19), por lo que se deberá mantener sedación profunda y trasladar al paciente a la Unidad de Cuidados Intensivos (UCI). Es importante recordar que la infección por COVID-19 se ha evidenciado en los principales sistemas, causando daño multiorgánico en los pacientes susceptibles, razón por la cual se deberá vigilar estrechamente todos los datos que nos lleven a pensar en disfunción a corto y mediano plazo. La toma de decisiones éticas respecto a qué paciente es candidato a una craniectomía descompresiva urgente o tratamiento endovascular, si más de un vaso está ocluido, se deberá discutir en conjunto con el equipo tratante para no caer en ensañamiento terapéutico, o bien, en la omisión de un tratamiento oportuno.

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Risk of Hyperglycemia and Hypoglycemia in Patients with Acute Ischemic Stroke Based on Continuous Glucose Monitoring

Cited by 16 publications

References 13 publications

Clinical relevance of glucose metrics during the early brain injury period after aneurysmal subarachnoid hemorrhage: An opportunity for continuous glucose monitoring

Clinical relevance of glucose metrics during the early brain injury period after aneurysmal subarachnoid hemorrhage: An opportunity for continuous glucose monitoring

Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline

Manejo perioperatorio del paciente neuroquirúrgico COVID-19

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