So how do we prevent glycemic variability? WHOM is going to answer that question? With NO STROKE LEADERSHIP, nothing will occur.
Don't just tell us there is a problem, SOLVE THE FUCKING PROBLEM! I'd be fired in no time if I never solved the problems I found.
Glycemic variability of acute stroke patients and clinical outcomes: a continuous glucose monitoring study
Abstract
Introduction:
Glycemic variability (GV) has been associated with worse prognosis in critically ill patients. We sought to evaluate the potential association between GV indices and clinical outcomes in acute stroke patients.
Methods:
Consecutive diabetic and nondiabetic, acute ischemic or hemorrhagic stroke patients underwent regular, standard-of-care finger-prick measurements and continuous glucose monitoring (CGM) for up to 96 h. Thirteen GV indices were obtained from CGM data. Clinical outcomes during hospitalization and follow-up period (90 days) were recorded. Hypoglycemic episodes disclosed by CGM but missed by finger-prick measurements were also documented.
Results:
A total of 62 acute stroke patients [48 ischemic and 14 hemorrhagic, median NIHSS score: 9 (IQR: 3–16) points, mean age: 65 ± 10 years, women: 47%, nondiabetic: 79%] were enrolled. GV expressed by higher mean absolute glucose (MAG) values was associated with a lower likelihood of neurological improvement during hospitalization before and after adjusting for potential confounders (OR: 0.135, 95% CI: 0.024–0.751, p = 0.022). There was no association of GV indices with 3-month clinical outcomes. During CGM recording, 32 hypoglycemic episodes were detected in 17 nondiabetic patients. None of these episodes were identified by the periodic blood glucose measurements and therefore they were not treated.
Introduction
Poststroke hyperglycemia is a common phenomenon in the acute setting of stroke and has been considered an independent predictor of poor clinical outcomes in both ischemic and hemorrhagic stroke.1–6 Thus, hyperglycemia management with intensive treatment had been expected to improve clinical outcomes. Despite the initial enthusiasm, randomized controlled clinical trials did not confirm the safety and efficacy of such treatment approaches.7,8 On the contrary, aggressive protocols with intravenous insulin infusions significantly increased the risk of hypoglycemia, which has been related to adverse functional outcomes in patients with acute ischemic stroke.9
By focusing strictly on hyperglycemia and hypoglycemia, however, we might have been overlooking a third independent component of dysglycemia: glycemic variability (GV), which is defined as the degree of fluctuation in glucose values over time.10 GV has been correlated with higher mortality risk in critically ill patients, even when mean glucose values are within normal limits.11,12 GV has been consistently overlooked in relevant randomized controlled clinical trials, although it may be a key reason why intensive glycemic control has failed to demonstrate significant clinical benefit in stroke patients.13,14 In recent years, there has been a growing interest regarding the role of GV in stroke outcomes in several observational studies.15–21 Those studies, however, are relatively limited either by the lack of continuous glucose monitoring (CGM) data or by the assessment of only a proportion of the existing GV indices.22
In this prospective, cohort study, we examined the association between GV and clinical outcomes in consecutive diabetic and nondiabetic, ischemic, and hemorrhagic acute stroke patients using CGM and calculated GV by measuring 13 different qualitative and quantitative indices. We hypothesized that increased GV in the acute stroke setting is associated with adverse short- and long-term clinical outcomes.
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