Abstract 7: Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring: COntinuous glucose Monitoring for acute stroke Patients receiving Latest treatment (COMPLEAT) Study

"Hyperglycaemia upon admission is a pathophysiological response to acute brain ischemia that has been independently associated with high mortality rate and poor prognosis. Glycaemic variability (GV) has also shown association with poor clinical outcomes among stroke patients. GV is best assessed by continuous glucose monitoring (CGM), which enables consecutives glucose measurements every 5 minutes. This pilot study aimed: 1) To describe safety, feasibility and tolerability of CGM in the acute stroke setting; and 2) To compare CGM and conventional FS glucose-based monitoring regimen in terms of their relationship with GUA and the accuracy of hypoglycaemic episodes detection. Safety, feasibility and tolerability of CGM was excellent in our cohort of 23 patients with acute stroke (61% ischemic and 39% intracerebral haemorrhage) and there were no adverse events. CGM recorded ten hypoglycaemic episodes that were not detected by conventional FS monitoring. GUA was associated with coefficient of variation (CV) of CGM (p=0.03), CV of FS (p=0.01), standard deviation (SD) of CGM (p-value=0.01) and mean amplitude of glucose excursions (MAGE) (pvalue= 0.001)."

Download Full-text

Glycemic variability of acute stroke patients and clinical outcomes: a continuous glucose monitoring study

Therapeutic Advances in Neurological Disorders ◽

10.1177/17562864211045876 ◽

2021 ◽

Vol 14 ◽

pp. 175628642110458

Author(s):

Lina Palaiodimou ◽

Vasileios-Arsenios Lioutas ◽

Vaia Lambadiari ◽

Aikaterini Theodorou ◽

Marios Themistocleous ◽

...

Keyword(s):

Acute Stroke ◽

Clinical Outcomes ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Glycemic Variability ◽

Standard Of Care ◽

Stroke Patients ◽

Neurological Improvement ◽

Finger Prick ◽

Before And After

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. Conclusions: Greater GV of acute stroke patients may be related to lower odds of neurological improvement during hospitalization. No association was disclosed between GV indices and 3-month clinical outcomes.

Download Full-text

A randomized trial to investigate the efficacy and safety of insulin glargine in hyperglycemic acute stroke patients receiving intensive care

Scientific Reports ◽

10.1038/s41598-021-91036-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sung-Chun Tang ◽

Shyang-Rong Shih ◽

Shin-Yi Lin ◽

Chih-Hao Chen ◽

Shin-Joe Yeh ◽

...

Keyword(s):

Intensive Care ◽

Insulin Glargine ◽

Acute Stroke ◽

Glucose Monitoring ◽

Regular Insulin ◽

Controlled Study ◽

Stroke Patients ◽

Open Label ◽

Neutral Protamine Hagedorn ◽

Basal Bolus

AbstractThis pilot, randomized, open-label controlled study compared the basal–bolus regimens of insulin glargine (IG) and neutral protamine Hagedorn (NPH) insulin in stroke patients with hyperglycemia receiving intensive care. The study recruited acute stroke patients requiring intensive care within 72 h (h) of onset and had blood glucose > 200 mg/dL. 50 patients received IG (n = 26) or NPH (n = 24) with added short-acting prandial regular insulin over a 72-h period. The primary end point was the percentage of glucose within 80–180 mg/dL assessed through continuous glucose monitoring. The baseline characteristics were comparable, except the IG had higher glucose pre-randomization than the NPH (290.69 ± 82.31 vs. 246.04 ± 41.76 mg/dL, P = 0.021). The percentage of time with glucose between 80 and 180 mg/dL was 45.88 ± 27.04% in the IG and 53.56 ± 22.89% in the NPH (P = 0.341) and the percentage of glucose reduction was 31.47 ± 17.52% in the IG and 27.28 ± 14.56% in the NPH (P = 0.374). The percentage of time with glucose < 60 mg/dL was 0.14 ± 0.49% in the IG and 0.47 ± 1.74% in the NPH. Poststroke outcomes were not significantly different. In conclusion, IG is safe and equally effective as an NPH-based basal-bolus regimen for acute stroke patients with hyperglycemia receiving intensive care.Trial registration ClinicalTrials.gov, NCT02607943. Registered 18/11/2015, https://clinicaltrials.gov/ct2/show/NCT02607943.

Download Full-text

Diabetic acute ischaemic stroke patients have an increase in glycemic variations assessed by continuous glucose monitoring: a multi-center, observational study

10.21203/rs.3.rs-17611/v1 ◽

2020 ◽

Author(s):

Han-rong Xu ◽

Zheng-gang Wu ◽

Feng-fei Li ◽

Guo Lu ◽

Xiao-qian Gong ◽

...

Keyword(s):

Glucose Metabolism ◽

Observational Study ◽

Ischaemic Stroke ◽

Continuous Glucose Monitoring ◽

Acute Ischaemic Stroke ◽

Glucose Monitoring ◽

Stroke Patients ◽

Abnormal Glucose Metabolism ◽

The Mean ◽

Glycemic Variations

Abstract Background One-third of acute ischaemic stroke (AIS) occurs in patients with an abnormal glucose metabolism, but little is known the differences in glycemic variations (GV) between stroke patients with and without abnormal glucose metabolism. The objective of this study was to observe the differences in GV between AIS patients with T2D and without T2D using continuous glucose monitoring (CGM). Methods This was a multi-center, prospective, observational study performed between March 2018 and September 2018 in 5 hospitals in China. After admission, all recruited patients were subjected to a consecutive 4-day CGM. At the endpoint, patients were divided into two groups according to the T2D status. The primary outcome was the differences in GV between AIS patients with and without T2D. Results A total of 149 patients (63 patients with T2D and 86 patients without T2D) were recruited into this study. AIS patients with T2D had a significant increase in the standard deviation of mean glucose, the mean amplitude glycemic excursions, the mean lowest glucose, the incremental area over the curve of hypoglycemia, the percentage of time spent in hypoglycemia, and the time in target range compared to those AIS patients without T2D (p<0.05 for all). Conclusions Our data demonstrates that AIS patients with T2D had a significant increase in GV compared to those without T2D. Our results indicated that therapies aimed to improvement in GV may be important to a better clinical outcome in patients with AIS after the onset of a stroke.

Download Full-text