title: Management of diabetes during acute stroke and inpatient stroke rehabilitation.
abstract: OBJECTIVE
  To summarize evidence on the impact of hyperglycemia on stroke outcomes and to present therapy algorithms for inpatient management in diabetic stroke patients.
  
  
  METHODS
  Guidelines for inpatient management of diabetes were reviewed and extracted from a technical review and recommendations from 2 national diabetes and endocrine organizations. MEDLINE database searches were conducted using key words: stroke, diabetes, hyperglycemia, hypoglycemia, inpatient, hospitalized, treatment, outcomes, disability, self-management, and education.
  
  
  METHODS
  Studies were selected that specifically addressed the impact of the following in stroke patients: hyperglycemia and diabetes on rehabilitation outcomes, management strategies for hyperglycemia and diabetes, and strategies for facilitating diabetes self-management.
  
  
  METHODS
  Two authors independently extracted data and management practices from selected articles and published practice guidelines.
  
  
  RESULTS
  Diabetes is prevalent in stroke patients and results in poorer inpatient hospital and rehabilitation outcomes. Management of diabetes in stroke patients is further complicated by impairments in mobility and vision, necessitating accommodation strategies and tools for self-management. Optimal management of hyperglycemia using insulin or oral hypoglycemic agents results in reduced morbidity and mortality among diabetic inpatients.
  
  
  CONCLUSIONS
  To achieve inpatient glycemic management targets, use of clinical management algorithms, self-management tools, and systems approaches such as diabetes management teams are useful.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. sahill@jhmi.edu
authors.forename: Sherita Hill
authors.initials: SH
authors.lastname: Golden
authors.forename: Felicia
authors.initials: F
authors.lastname: Hill-Briggs
authors.forename: Kathleen
authors.initials: K
authors.lastname: Williams
authors.forename: Karen
authors.initials: K
authors.lastname: Stolka
authors.forename: R Samuel
authors.initials: RS
authors.lastname: Mayer
mesh_terms: D000465:Algorithms; D035843:Biomedical Research; D003680:Deglutition Disorders / Q000628:therapy; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012648:Self Care; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation
chemical_list: D007004:Hypoglycemic Agents