Background and purpose: Association of dynamic variation of blood glucose during initial days after stroke onset with stroke outcomes has not been yet clarified. The purpose of this study was to examine the relationship between glucose barometers obtained by continuous glucose monitoring (CGM) and clinical outcomes in acute stroke patients.
Methods: Continuous patients with acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) within 24 hours after onset were included. CGM device (iPro2) was attached for the initial 72 hours after emergent admission. Seven glucose barometers were obtained from CGM: maximum, minimum, mean, and standard deviation of blood glucose levels, as well as area under the curve more than 8 mmol/L blood glucose (8AUC), distribution time more than 8 mmol/L blood glucose (8time-ratio), and presence of time less than 3.9 mmol/L during 72 hours. Primary outcome measure was unfavorable clinical outcome at 3 months (mRS ≥3). Secondary outcome measure was early neurological deterioration after stroke (an increase of ≥4 NIHSS scores from the baseline or death) within 7 days.
Results: One hundred patients with AIS (n=58) or ICH (n=42) were included. Blood glucose level varied between 5.2±1.4 mmol/L and 11.4±3.3 mmol/L during 72 hours with 8AUC of 0.7±1.4 minхmmol/L, 8time-ratio of 31.7±32.7%, and presence of hypoglycemia in 15% of the overall patients. Mean glucose level (adjusted OR 1.59, 95% CI 1.13-2.25 /1 mmol/L), 8AUC (2.06, 1.14-3.72 /1 minхmmol/L) and 8time-ratio (1.25, 1.05-1.49 /10%)were related to unfavorable outcome for overall patients, as well as for AIS patients (2.11, 1.26-3.53; 2.43, 1.24-4.78; 1.72, 1.23-2.39, respectively). Only 8time-ratio was related to neurological deterioration for overall patients (adjusted OR 1.49, 95% CI 1.08-2.05 /10%).
Conclusion: High mean glucose levels, 8time-ratio and 8 AUC levels were associated with unfavorable outcome at 3 months. High 8time-ratio levels were related to early neurological deterioration within 7 days.