Beyond hyperglycemia: glycaemic variability as a prognostic factor after acute ischemic stroke

Area of Science:

• Neurology
• Endocrinology
• Clinical Medicine

Background:

• Glycaemic variability (GV) signifies fluctuations in blood glucose levels.
• GV is increasingly recognized as a potential factor influencing stroke outcomes.
• Understanding GV's role in acute ischaemic stroke is crucial for improving patient prognosis.

Purpose of the Study:

• To evaluate the association between glycaemic variability (GV) and the progression of acute ischaemic stroke.
• To determine if GV is an independent predictor of mortality and functional outcomes post-stroke.
• To investigate the influence of insulin administration routes on GV.

Main Methods:

• Exploratory analysis of the prospective, observational GLIAS-II study.
• Capillary glucose monitoring every 4 hours for the initial 48 hours post-stroke.
• GV quantified as the standard deviation of mean glucose values; primary outcomes: 3-month mortality and death/dependency.

Main Results:

• Higher GV observed in non-survivors (30.9 mg/dL vs 23.3 mg/dL).
• Adjusted logistic regression revealed GV (OR 1.03) and stroke severity (OR 1.12) as independent predictors of 3-month mortality.
• Subcutaneous insulin associated with significantly higher GV than intravenous insulin (38.95 mg/dL vs 21.34 mg/dL).

Conclusions:

• Elevated glycaemic variability within 48 hours post-ischaemic stroke is independently linked to increased mortality.
• The route of insulin administration may influence GV levels, with subcutaneous potentially leading to higher variability.
• Further research into GV management strategies post-stroke is warranted.