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Palaiodimou L, Lioutas VA, Lambadiari V, Theodorou A, Themistocleous M, Aponte L, Papagiannopoulou G, Foska A, Bakola E, Quispe R, Mendez L, Selim M, Novak V, Tzavellas E, Halvatsiotis P, Voumvourakis K, Tsivgoulis G. Glycemic variability of acute stroke patients and clinical outcomes: a continuous glucose monitoring study. Ther Adv Neurol Disord 2021; 14:17562864211045876. [PMID: 34589140 PMCID: PMC8474316 DOI: 10.1177/17562864211045876] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/24/2021] [Indexed: 01/04/2023] Open
Abstract
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.
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Affiliation(s)
- Lina Palaiodimou
- Second Department of Neurology, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | | | - Vaia Lambadiari
- Second Department of Internal Medicine-Propaedeutic and Diabetes Center, Medical School, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Theodorou
- Second Department of Neurology, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Marios Themistocleous
- Department of Neurosurgery, Pediatric Hospital of Athens, Agia Sophia, Athens, Greece
| | - Laura Aponte
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Georgia Papagiannopoulou
- Second Department of Neurology, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Foska
- Second Department of Neurology, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Bakola
- Second Department of Neurology, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Rodrigo Quispe
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Laura Mendez
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Magdy Selim
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Vera Novak
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elias Tzavellas
- First Department of Psychiatry, Aiginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Halvatsiotis
- Second Department of Internal Medicine-Propaedeutic and Diabetes Center, Medical School, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Voumvourakis
- Second Department of Neurology, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Rimini 1, Chaidari, Athens 12462, Greece
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Palaiodimou L, Lioutas VA, Lambadiari V, Paraskevas GP, Voumvourakis K, Tsivgoulis G. Glycemia management in acute ischemic stroke: current concepts and novel therapeutic targets. Postgrad Med 2019; 131:423-437. [DOI: 10.1080/00325481.2019.1651206] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Lina Palaiodimou
- Second Department of Neurology, “Attikon” University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Vaia Lambadiari
- Second Department of Internal Medicine, Research Institute and Diabetes Center, Athens University Medical School, “Attikon” University Hospital, Haidari, Greece
| | - George P. Paraskevas
- Cognitive and Movement Disorders Unit and Unit of Neurochemistry and Biological Markers, First Department of Neurology, “Eginition” University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Voumvourakis
- Second Department of Neurology, “Attikon” University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
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