The Fluctuation of Blood Glucose Level in Stroke Patients without History of Diabetes Mellitus: Relationship with its Outcome

Abstract

Purpose: In the present study we aimed at evaluating the fluctuation of fasting glucose levels and analyzing its relationship with outcomes in nondiabetic patients with ischemic stroke and intracerebral hemorrhage. Methods: We conducted a prospective study involving 316 nondiabetic patients (225 male, 91 female) with hemorrhagic and ischemic stroke, who were admitted to the Pyongyang University of Medical Sciences Hospital, Democratic People’s Republic of Korea from April 2017 to December 2019. The patients with subarachnoid hemorrhage, traumatic intracranial hematoma, transient ischemic attack (TIA) and stroke with history of diabetes mellitus were excluded from the study. Fasting glucose levels at day 1 after admission and, at day 7 and day 14 after onset were measured. The fasting glucose level of ≧126 mg/dl was defined as hyperglycemia (HG). The stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS). In the present study, in-hospital mortality was analyzed for primary outcome and modified Rankin Scale (mRS)>2 at 90 days was assessed after onset for secondary outcome. Results: Proportion of patients with HG accounted for 45.2% with intracerebral hemorrhage at day 1 after admission, reduced to 3.9% at day 7 and normal fasting glucose levels were observed in all of them at day 14. As regards patients with ischemic stroke, nevertheless no significant differences between mean level of fasting glucose during onset (113.39±18.01 mg/dl) and that at day 7 (112.22±16.02mg/dl) the proportion of HG was increased (24.6%), whereas the level at day 14 was significantly reduced as compared to those during onset (106.26±14.27 mg/dl), but the proportion of patients with consistent HG was found to be 13.5%. In-hospital mortality (19.2%) and the proportion of patients with >2 mRS at 90 days (81.0%) in patients with HG were significantly increased as compared to normoglycemic patients (0%, 48.1%, respectively). In logistic regression model, NIHSS at admission, fasting glucose level during onset, history of hyperlipidemia and diastolic blood pressure (DBP) at admission were independent predictors of in-hospital mortality. On the other hand, NIHSS at admission, fasting glucose level at day 7, hypertension, smoking and peripheral leukocyte counts at admission were independent predictors of poor outcome at 90 days. Conclusion: In ischemic stroke, HG after stroke often continued to 14 days, as well as to 7 days, whereas in intracerebral hemorrhage blood glucose level went down to normal at day 7 and none of hyperglycemic patients were found at day 14. We concluded that monitoring and management of blood glucose level may be needed even in nondiabetic stroke patients because HG during onset is a predictor for in-hospital mortality and HG at day 7 is a predictor for the outcome at 90 days.

Keywords: Diabetes mellitus, hyperglycemia, hyperlipidemia, nondiabetic stroke, stress hyperglycemia

Cite this Article

Son-Hyang Cha, Ryong Kim, Jong-Sun Kim, Chol-Ho Sin, Sin-Ho Hwang, Chun-Hua Choe. The Fluctuation of Blood Glucose Level in Stroke Patients without History of Diabetes Mellitus: Relationship with its Outcome. Research & Reviews: A Journal of Neuroscience. 2020; 10(3):
5–11p.