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DOI: 10.2337/dc06-0204
© 2006 by the American Diabetes Association
Pathophysiology/Complications |
Frequency and Temporal Profile of Poststroke Hyperglycemia Using Continuous Glucose Monitoring
1 Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
2 Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
3 Department of Clinical Epidemiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
4 Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
Address correspondence and reprint requests to Prof. Stephen Davis, Director of Neurology, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia. E-mail: stephen.davis{at}mh.org.au
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 (
7 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.
Abbreviations: cFPG, capillary finger-prick glucose • CGM, continuous glucose monitoring • CGMS, continuous glucose monitoring system • MRI, magnetic resonance imaging • NGF, nasogastric tube feeding • PSH, poststroke hyperglycemia
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