Der Diabetologe

, Volume 9, Issue 3, pp 210–216

„Post-stroke“-Hyperglykämie

Persistierende Hyperglykämie beim akuten Schlaganfall
Leitthema

Zusammenfassung

Bei Patienten mit ischämischem Hirninfarkt ist die Hyperglykämie in der Akutphase ein häufiges Phänomen, das bei 40–70 % der Betroffenen, auch ohne bekannten Diabetes mellitus, auftritt. Die Glukosedysregulation persistiert meist für etwa 24–72 h. Ursächlich sind u. a. eine relative Insulinresistenz und Stresshyperglykämie im Rahmen der akuten zerebralen Ischämie. Immer noch wird kontrovers diskutiert, ob diese „Post-stroke“-Hyperglykämie (PSH) Ursache oder Folge eines ungünstigen Schlaganfallverlaufs ist. Aktuell gilt die PSH als unabhängiger Prädiktor für schlechteres funktionelles Outcome und erhöhte Mortalität nach einem Schlaganfall. Aus diesem Grund rückt sie als therapeutisches „target“ immer mehr in den Vordergrund. Die Studienlage zur Therapie ist limitiert. Zudem gelang es bisher nicht, die Wirksamkeit einer schnellen, intensivierten Insulintherapie beim akuten Schlaganfall nachzuweisen, mitbedingt durch Mängel in der Methodik und auftretende iatrogene Hypoglykämien. Bis die Ergebnisse neuerer Studien vorliegen, wird in Zusammenschau der aktuellen Leitlinien zu einem vorsichtigen Blutzuckermanagement mit Toleranz von Werten bis etwa 7,8–10,0 mmol/l geraten.

Schlüsselwörter

Zerebraler Infarkt Ischämie Diabetes mellitus Insulin Hypoglykämie 

Post-stroke hyperglycemia

Persistent hyperglycemia in acute stroke

Abstract

Post-stroke hyperglycemia (PSH) occurs in 40–70 % of patients with acute ischemic stroke, even in patients without known diabetes mellitus. Glucose dysregulation persists for approximately 24–72 h after stroke onset and is probably caused by a relative insulin resistance and stress hyperglycemia due to acute ischemia. Controversy still exists whether PSH is the cause or result of an unfavourable stoke course but is currently held to be a predictor of worse stroke outcome. Most studies showed a deleterious effect of PSH as it was independently associated with increased mortality and poorer functional outcome. Until now randomized trial data remain limited and offer no strong support for aggressive insulin interventional therapy in stroke most likely because of different treatment regimens and the risk of hypoglycemic episodes without closed monitoring. Until further trial data are available consensus guidelines are generally conservative for blood glucose levels up to approximately 7.8–10.0 mmol/l.

Keywords

Cerebral infarction Ischemia Diabetes mellitus Insulin Hypoglycemia 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Neurologische KlinikUniversitätsklinikum ErlangenErlangenDeutschland

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