Management of diabetes during acute stroke and inpatient stroke rehabilitation.
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.
Golden
Sherita Hill
SH
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. sahill@jhmi.edu
Hill-Briggs
Felicia
F
Williams
Kathleen
K
Stolka
Karen
K
Mayer
R Samuel
RS
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
D007004:Hypoglycemic Agents