Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

• Published in: Journal of the American Heart Association Vol. 7; no. 8
• Main Authors: Wada, Shinichi, Yoshimura, Sohei, Inoue, Manabu, Matsuki, Takayuki, Arihiro, Shoji, Koga, Masatoshi, Kitazono, Takanari, Makino, Hisashi, Hosoda, Kiminori, Ihara, Masafumi, Toyoda, Kazunori
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 17.04.2018; Wiley
• Subjects: Acute Disease; acute stroke; Aged; Biomarkers - blood; Blood Glucose - metabolism; Blood Glucose Self-Monitoring - methods; Brain Ischemia - blood; Brain Ischemia - epidemiology; Brain Ischemia - etiology; continuous glucose monitoring; diabetes mellitus; Female; Follow-Up Studies; Humans; hyperglycemia; Hyperglycemia - blood; Hyperglycemia - complications; Incidence; Japan - epidemiology; Male; Original Research; outcome; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Factors; Survival Rate - trends; Japan; hyperglycemia; diabetes mellitus; acute stroke; continuous glucose monitoring; outcome
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.118.008744

Background The purpose of this study was to examine the relationships between glucose parameters obtained by continuous glucose monitoring and clinical outcomes in acute stroke patients. Methods and Results Consecutive patients with acute ischemic stroke or intracerebral hemorrhage within 24 hours after onset were included. A continuous glucose monitoring device (iPro2) was attached for the initial 72 hours after emergent admission. Eight glucose parameters were obtained from continuous glucose monitoring: maximum, minimum, mean, and SD of blood glucose levels, as well as area under the curve more than 8 mmol/L of blood glucose, distribution time more than 8 mmol/L of blood glucose, coefficient of variation (%CV), and presence of time less than 4 mmol/L over 72 hours. The primary outcome measure was death or dependency at 3 months (modified Rankin Scale score ≥3). One hundred patients with acute ischemic stroke (n=58) or intracerebral hemorrhage (n=42) were included. Blood glucose levels varied between 5.2±1.4 and 11.4±3.2 mmol/L over 72 hours, with area under the curve more than 8 mmol/L of blood glucose of 0.7±1.4 min×mmol/L, distribution time more than 8 mmol/L of blood glucose of 31.7±32.7%, coefficient of variation of 15.5±5.4%, and presence of hypoglycemia in 20% of overall patients. Mean glucose level (adjusted odds ratio, 1.60, 95% confidence interval, 1.12–2.28/1 mmol/L), area under the curve more than 8 mmol/L of blood glucose (2.13, 1.12–4.02/1 min×mmol/L), and distribution time more than 8 mmol/L of blood glucose (1.25, 1.05–1.50/10%) were related to death or dependency for overall patients, as well as for acute ischemic stroke patients (2.05, 1.15–3.65; 2.38, 1.04–5.44; 1.85, 1.10–3.10, respectively). Conclusions High mean glucose levels, distribution time more than 8 mmol/L of blood glucose, and areas under the curve more than 8 mmol/L of blood glucose during the initial 72 hours of acute stroke were associated with death or dependency at 3 months.