Glycemia in Acute Stroke II study: a call to improve post‐stroke hyperglycemia management in clinical practice. (14th July 2017)

• Record Type: Journal Article
• Authors: Fuentes, B.; Sanz‐Cuesta, B. E.; Gutiérrez‐Fernández, M.; Martínez‐Sánchez, P.; Lisbona, A.; Madero‐Jarabo, R.; Delgado‐Mederos, R.; Gállego‐Cullere, J.; Rodríguez‐Yáñez, M.; Martínez‐Zabaleta, M.; Freijo, M.; Alonso de Leciñana, M.; Portilla, J. C.; Gil‐Núñez, A.; Díez‐Tejedor, E.
• Other Names: Ruiz‐Ares Gerardo investigator.; Rodríguez‐Frutos Berta investigator.; Ramos‐Cejudo Jaime investigator.; Otero‐Ortega Laura investigator.; Prefasi Daniel investigator.; Mangas‐Guijarro María Ángeles investigator.; Pallardo Luis Felipe investigator.; Frutos Remedios investigator.; Fernández‐Prieto Andres investigator.; Madero Rosario investigator.; Almirón Mariana Díaz investigator.; García‐Sánchez Juan Manuel investigator.; Gállego Jaime investigator.; Aymerich Nuria investigator.; Blanco Miguel investigator.; Díez‐González Noemí investigator.; de Arce Ana investigator.; González Félix investigator.; Martí‐Fábregas Joan investigator.; Fernández‐Fournier Mireya investigator.; Díaz‐Otero Fernando investigator.; Álvarez‐Linera Juan investigator.
• Is Part Of: European journal of neurology. Volume 24:Number 9(2017:Sep.)
• Page Start: 1091
• Page End: 1098
• Publication Date: 2017-07-14
• Subjects: acute ischaemic stroke -- hyperglycemia -- insulin -- outcome; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.13354
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract : Background and purpose: The aim of the study was to analyze the effect of conventional glucose management, which aimed to maintain glucose levels <155 mg/dL (8.5 mmol/L), on glucose control and the outcomes of patients with acute ischaemic stroke (IS) in a clinical practice setting. Methods: This was a multicenter, prospective cohort study of patients with acute IS. Patients were classified into four groups based on their initial 48‐h capillary glucose levels and the administration of and response to corrective treatment: (i) untreated and maximum glucose levels <155 mg/dL (8.5 mmol/L) within the first 48 h; (ii) treated and good responders [glucose levels persistently <155 mg/dL (8.5 mmol/L)]; (iii) treated and non‐responders [any glucose values ≥155 mg/dL (8.5 mmol/L) during the 24 h after the start of corrective treatment]; and (iv) untreated with any glucose value ≥155 mg/dL (8.5 mmol/L). The primary outcome was death or dependence at 3 months (blinded rater). Results: A total of 213 patients were included. Ninety‐seven (45.5%) patients developed glucose levels ≥155 mg/dL (8.5 mmol/L), 69 (71.1%) underwent corrective treatment and 31 patients underwent no corrective treatment at the physician's discretion [28 of whom had isolated values ≥155 mg/dL (8.5 mmol/L)]. Only 11 (16%) patients responded to conventional treatment, whereas 58 (84%) patients were non‐responsive. Non‐responders showed a twofold higher risk of death or dependence at 3 months (odds ratio, 2.472; 95% confidence interval, 1.096–5.576; P = 0.029). Conclusions: Lack of response to conventional treatment for glucose management in acute IS is frequent and associated with poor outcomes. Abstract : Clickhere for the corresponding questions to this CME article.