title: Hyperglycaemia monitoring and management in stroke care: policy vs. practice.
abstract: OBJECTIVE
  To evaluate the extent to which hyperglycaemia was monitored and managed among patients admitted to hospital with acute stroke and transient ischaemic attack.
  
  
  METHODS
  We conducted a retrospective cohort study involving a review of the records of 112 patients consecutively admitted with acute stroke or transient ischaemic attack to all three district general hospitals in one Health and Social Care Trust in Northern Ireland from 1 January to 15 April 2008. Glucose results for each of the first 5 days of hospital admission were ascertained. We compared interventions, clinical outcome and discharge planning between patients who experienced glucose ≥ 7.8 mmol/l in the first 5 days, and patients with lower glucose results.
  
  
  RESULTS
  The daily prevalence rate of hyperglycaemia > 7.8 mmol/l across the first 5 days ranged from 24 to 34%. A total of 41 (37%) patients experienced hyperglycaemia on at least one occasion during the first 5 days. A history of diabetes mellitus prompted near patient glucose testing, but, among patients without diagnosed diabetes, glycaemia was under-monitored. Hyperglycaemia was a persisting trend, was under-treated and under-reported to general practitioners. Elevated glucose results failed to influence higher rates of fasting plasma glucose tests and BMI assessment.
  
  
  CONCLUSIONS
  There is a need for greater vigilance in the detection of hyperglycaemia and undiagnosed diabetes mellitus among patients admitted to hospital with stroke or transient ischaemic attack.
authors.affiliation: School of Nursing, University of Ulster, Derry, UK. ea.mitchell@ulster.ac.uk
authors.forename: E A
authors.initials: EA
authors.lastname: Mitchell
authors.forename: V E
authors.initials: VE
authors.lastname: Coates
authors.forename: A A
authors.initials: AA
authors.lastname: Ryan
authors.forename: M O
authors.initials: MO
authors.lastname: McCarron
authors.forename: D
authors.initials: D
authors.lastname: Lyttle
authors.forename: E
authors.initials: E
authors.lastname: McCrum-Gardner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D006291:Health Policy; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000453:epidemiology / Q000628:therapy*; D007297:Inpatients; D002546:Ischemic Attack, Transient / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009660:Northern Ireland; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012189:Retrospective Studies; D020521:Stroke / Q000097:blood* / Q000628:therapy*
chemical_list: D001786:Blood Glucose