Management of blood glucose in patients with stroke

• Published in: Diabetes & metabolism Vol. 36; pp. S94 - S99
• Main Authors: Radermecker, R.P, Scheen, A.J
• Format: Journal Article Conference Proceeding Web Resource
• Language: English
• Published: Paris Elsevier Masson SAS 01.10.2010; Masson
• Subjects: Accident vasculaire cérébral; Biological and medical sciences; Blood Glucose - metabolism; Cardiovascular & respiratory systems; CGMS; Diabetes; Diabetes. Impaired glucose tolerance; Diabète; Endocrine pancreas. Apud cells (diseases); Endocrinologie, métabolisme & nutrition; Endocrinology & Metabolism; Endocrinology, metabolism & nutrition; Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Human health sciences; Humans; Hyperglycaemia; Hyperglycemia - drug therapy; Hyperglycemia - prevention & control; Hyperglycémie; Hypoglycaemia; Hypoglycemia - drug therapy; Hypoglycemia - prevention & control; Hypoglycémie; Insulin therapy; Insulinothérapie; Internal Medicine; Medical sciences; Neurology; Review; Revue; Sciences de la santé humaine; Stroke; Stroke - blood; Systèmes cardiovasculaire & respiratoire; Vascular diseases and vascular malformations of the nervous system; Revue; Stroke; Hyperglycaemia; Hypoglycaemia; Diabète; Review; Hypoglycémie; Insulin therapy; CGMS; Insulinothérapie; Accident vasculaire cérébral; Diabetes; Hyperglycémie; Endocrinopathy; Human; Nervous system diseases; Diabetes mellitus; Metabolic diseases; Cardiovascular disease; Glucose; Hypoglycemia; Cerebral disorder; Vascular disease; Hyperglycemia; Central nervous system disease; Cerebrovascular disease
• ISSN: 1262-3636; 1878-1780; 1878-1780
• DOI: 10.1016/S1262-3636(10)70474-2

Abstract Stroke is a leading cause of death worldwide and the most common cause of long-term disability amongst adults, more particularly in patients with diabetes mellitus and arterial hypertension. Increasing evidence suggests that disordered physiological variables following acute ischaemic stroke, especially hyperglycaemia, adversely affect outcomes. Post-stroke hyperglycaemia is common (up to 50% of patients) and may be rather prolonged, regardless of diabetes status. A substantial body of evidence has demonstrated that hyperglycaemia has a deleterious effect upon clinical and morphological stroke outcomes. Therefore, hyperglycaemia represents an attractive physiological target for acute stroke therapies. However, whether intensive glycaemic manipulation positively influences the fate of ischaemic tissue remains unknown. One major adverse event of management of hyperglycaemia with insulin (either glucose-potassium-insulin infusions or intensive insulin therapy) is the occurrence of hypoglycaemia, which can also induce cerebral damage. Novel insights into post-stroke hyperglycaemia management have been derived from continuous glucose monitoring systems (CGMS). This article aims: 1) to describe the adverse effects of hyperglycaemia following acute ischaemic stroke and the risk associated with iatrogenic hypoglycaemia; 2) to summarise the evidence from current glucose-lowering treatment trials; and 3) to show the usefulness of CGMS in both non-diabetic and diabetic patients with acute stroke.