Background: The aim of the present study was to clarify the effect of glucose profiles after stroke, which was assessed by a continuous glucose monitoring (CGM) device. Methods: Acute ischemic stroke patients within 24 h of onset were prospectively studied. CGM was performed for 72 h after admission. CGM parameters were evaluated as follows: (1) mean glucose level, (2) area under the curve (AUC) for glucose level >140 mg/dl and (3) SD of the glucose level. Infarct volume was measured at admission and 24 and 72 h after admission using diffusion-weighted imaging. CGM data and infarct volume growth were compared at 24 and 72 h. Results: Seventy-eight patients were enrolled in the present study. Spearman's rank correlation coefficients showed that both the mean glucose level (r = 0.433, p < 0.001 for 24 h; r = 0.308, p = 0.006 for 72 h) and AUC >140 mg/dl (r = 0.417, p < 0.001 for 24 h; r = 0.277, p = 0.014 for 72 h) were significantly correlated with acute infarct volume growth. The SD of the glucose level was associated with infarct volume growth at 24 h (r = 0.303, p = 0.007), but not 72 h (r = 0.195, p = 0.088). Conclusion: Post-stroke hyperglycemia was associated with infarct volume growth during the acute phase of ischemic stroke.

1.
Parsons MW, Barber PA, Desmond PM, Baird TA, Darby DG, Byrnes G, Tress BM, Davis SM: Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol 2002;52:20-28.
2.
Kimura K, Sakamoto Y, Iguchi Y, Shibazaki K, Aoki J, Sakai K, Uemura J: Admission hyperglycemia and serial infarct volume after t-PA therapy in patients with and without early recanalization. J Neurol Sci 2011;307:55-59.
3.
Ribo M, Molina C, Montaner J, Rubiera M, Delgado-Mederos R, Arenillas JF, Quintana M, Alvarez-Sabín J: Acute hyperglycemia state is associated with lower tPA-induced recanalization rates in stroke patients. Stroke 2005;36:1705-1709.
4.
Melikian N, Seddon MD, Casadei B, Chowienczyk PJ, Shah AM: Neuronal nitric oxide synthase and human vascular regulation. Trends Cardiovasc Med 2009;19:256-262.
5.
Kamada H, Yu F, Nito C, Chan PH: Influence of hyperglycemia on oxidative stress and matrix metalloproteinase-9 activation after focal cerebral ischemia/reperfusion in rats: relation to blood-brain barrier dysfunction. Stroke 2007;38:1044-1049.
6.
Sonneville R, den Hertog HM, Güiza F, Gunst J, Derese I, Wouters PJ, Brouland JP, Polito A, Gray F, Chrétien F, Charlier P, Annane D, Sharshar T, Van den Berghe G, Vanhorebeek I: Impact of hyperglycemia on neuropathological alterations during critical illness. J Clin Endocrinol Metab 2012;97:2113-2123.
7.
Paciaroni M, Agnelli G, Caso V, Corea F, Ageno W, Alberti A, Lanari A, Micheli S, Bertolani L, Venti M, Palmerini F, Billeci AM, Comi G, Previdi P, Silvestrelli G: Acute hyperglycemia and early hemorrhagic transformation in ischemic stroke. Cerebrovasc Dis 2009;28:119-123.
8.
Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC: Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 2001;32:2426-2432.
9.
Mastrototaro J: The MiniMed continuous glucose monitoring system (CGMS). J Pediatr Endocrinol Metab 1999;12(suppl 3):751-758.
10.
Baird TA, Parsons MW, Phan T, Butcher KS, Desmond PM, Tress BM, Colman PG, Chambers BR, Davis SM: Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke 2003;34:2208-2214.
11.
Ribo M, Molina CA, Delgado P, Rubiera M, Delgado-Mederos R, Rovira A, Munuera J, Alvarez-Sabin J: Hyperglycemia during ischemia rapidly accelerates brain damage in stroke patients treated with tPA. J Cereb Blood Flow Metab 2007;27:1616-1622.
12.
Su G, Mi SH, Tao H, Li Z, Yang HX, Zheng H, Zhou Y, Tian L: Impact of admission glycemic variability, glucose, and glycosylated hemoglobin on major adverse cardiac events after acute myocardial infarction. Diabetes Care 2013;36:1026-1032.
13.
Teraguchi I, Imanishi T, Ozaki Y, Tanimoto T, Ueyama M, Orii M, Shiono Y, Shimamura K, Ishibashi K, Yamano T, Ino Y, Yamaguchi T, Hirata K, Kubo T, Sanke T, Akasaka T: Acute-phase glucose fluctuation is negatively correlated with myocardial salvage after acute myocardial infarction. Circ J 2013;78:170-179.
14.
Ceriello A, Esposito K, Piconi L, Ihnat MA, Thorpe JE, Testa R, Boemi M, Giugliano D: Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes 2008;57:1349-1354.
15.
Alvarez-Sabín J, Molina CA, Montaner J, Arenillas JF, Huertas R, Ribo M, Codina A, Quintana M: Effects of admission hyperglycemia on stroke outcome in reperfused tissue plasminogen activator-treated patients. Stroke 2003;34:1235-1241.
16.
Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke 1993;24:35-41.
17.
Rosso C, Corvol JC, Pires C, Crozier S, Attal Y, Jacqueminet S, Deltour S, Multlu G, Leger A, Meresse I, Payan C, Dormont D, Samson Y: Intensive versus subcutaneous insulin in patients with hyperacute stroke: results from the randomized INSULINFARCT trial. Stroke 2012;43:2343-2349.
18.
Cho KH, Kwon SU, Lee DH, Shim W, Choi C, Kim SJ, Suh DC, Kim JS, Kang DW: Early infarct growth predicts long-term clinical outcome after thrombolysis. J Neurol Sci 2012;316:99-103.
19.
Kawai N, Keep RF, Betz AL: Hyperglycemia and the vascular effects of cerebral ischemia. Stroke 1997;28:149-154.
20.
Larrue V, von Kummer R R, Müller A, Bluhmki E: Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian acute stroke study (ECASS II). Stroke 2001;32:438-441.
21.
Higashida RT, Furlan AJ, et al: Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 2003;34:e109-e137.
22.
Luitse MJ, Biessels GJ, Rutten GE, Kappelle LJ: Diabetes, hyperglycaemia, and acute ischaemic stroke. Lancet Neurol 2012;11:261-271.
23.
van Kooten F, Hoogerbrugge N, Naarding P, Koudstaal PJ: Hyperglycemia in the acute phase of stroke is not caused by stress. Stroke 1993;24:1129-1132.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.