Frequency and temporal profile of poststroke hyperglycemia using continuous glucose monitoring.
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.


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 (> or =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.
Allport
Louise
L
Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Baird
Tracy
T
Butcher
Ken
K
Macgregor
Lachlan
L
Prosser
Jane
J
Colman
Peter
P
Davis
Stephen
S
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000378:metabolism; D004032:Diet; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications*
D001786:Blood Glucose