The initial glycemic variability is associated with early neurological deterioration in diabetic patients with acute ischemic stroke
- 111 Downloads
The association between glycemic variability and early neurological deterioration (END) in acute ischemic stroke remains unclear. This study attempted to explore whether initial glycemic variability increases END in diabetic patients with acute ischemic stroke. We enrolled type 2 diabetic patients undergoing acute ischemic stroke from November 2015 to November 2016. A total of 336 patients within 72 h from stroke onset were included. The serum glucose levels were checked four times per day during the initial 3 hospital days. The standard deviation of blood glucose (SDBG) values and the mean amplitude of glycemic excursions (MAGE) were calculated for glycemic variability. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) ≥ 2 points between hospital days 0 and 5. The frequencies of END and HbA1c were significantly different in subjects grouped according to tertiles of MAGE (9.09, 12.07 and 50.00%, p < 0.001 for END; 7.36 ± 1.91, 7.83 ± 1.93 and 8.56 ± 1.79, p < 0.001 for HbA1c). Compared to patients without END, patients with END had significantly higher HbA1c levels (8.30 ± 1.92 vs 7.80 ± 1.93, p = 0.043), increased SDBG (3.42 ± 1.14 vs 2.60 ± 0.96, p < 0.001), and increased MAGE (6.46 ± 2.09 vs 4.59 ± 1.91, p < 0.001). In a multivariable logistic regression, stroke etiology (OR 0.675; 95% CI 0.485–0.940, p = 0.020), baseline NIHSS (OR 1.086; 95% CI 1.004–1.175, p = 0.040), and MAGE (OR 1.479; 95% CI 1.162–1.882, p = 0.001) were significantly associated with END. Initial glycemic variability is associated with END in diabetic patients with acute ischemic stroke.
KeywordsAcute ischemic stroke Glycemic variability Early neurological deterioration
This research was supported by National Natural Science Foundation of China (No.81201051, Guangjun Xi; No.81401619, Jiaojie Hui; No.81671219, Zaiwang Li), Natural Science Foundation of Jiangsu Province (No.BK2012097, Guangjun Xi; No.BK20151109, Zaiwang Li) and Medical Young Talents Program of Jiangsu Province (No.QNRC2016191, Guangjun Xi; No.QNRC2016178, Jiaojie Hui).
Compliance with ethical standards
All study documents and procedures were approved by the Ethics Committees at all participating hospitals. All patients or their designated relatives gave their written informed consent prior to participation in this study. There was no delay in patients’ receiving treatment due to participation of the study.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, Creager MA, Culebras A, Eckel RH, Hart RG, Hinchey JA, Howard VJ, Jauch EC, Levine SR, Meschia JF, Moore WS, Nixon JV, Pearson TA (2011) Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42:517–584CrossRefPubMedGoogle Scholar
- 5.Gray CS, Hildreth AJ, Sandercock PA, O’Connell JE, Johnston DE, Cartlidge NE, Bamford JM, James OF, Alberti KG (2007) Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia: the UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurol 6:397–406CrossRefPubMedGoogle Scholar
- 12.Seners P, Baron JC (2017) Revisiting ‘progressive stroke’: incidence, predictors, pathophysiology, and management of unexplained early neurological deterioration following acute ischemic stroke. J Neurol 265:216–225Google Scholar
- 28.Costantino S, Paneni F, Battista R, Castello L, Capretti G, Chiandotto S, Tanese L, Russo G, Pitocco D, Lanza GA, Volpe M, Luscher TF, Cosentino F (2017) Impact of glycemic variability on chromatin remodeling, oxidative stress and endothelial dysfunction in type 2 diabetic patients with target HbA1c levels. Diabetes 66:2472–2482Google Scholar
- 30.Llombart V, Dominguez C, Bustamante A, Rodriguez-Sureda V, Martin-Gallan P, Vilches A, Garcia-Berrocoso T, Penalba A, Hernandez-Guillamon M, Rubiera M, Ribo M, Eschenfelder C, Giralt D, Molina CA, Alvarez-Sabin J, Rosell A, Montaner J (2014) Fluorescent molecular peroxidation products: a prognostic biomarker of early neurologic deterioration after thrombolysis. Stroke 45:432–437CrossRefPubMedGoogle Scholar