Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, Kanagawa, Japan.
Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, Kanagawa, Japan.
J Stroke Cerebrovasc Dis. 2019 Dec;28(12):104346. doi: 10.1016/j.jstrokecerebrovasdis.2019.104346. Epub 2019 Sep 21.
In patients with acute ischemic stroke, current guidelines recommend maintaining blood glucose levels in a range of 140-180 mg/dL and closely monitoring to prevent hypoglycemia (<60 mg/dL). We aimed to assess glucose variability by continuous glucose monitoring (CGM) and to demonstrate the risk of acute ischemic stroke patients with glucose levels outside of the glucose management recommendations.
Patients with ischemic stroke admitted within 7 days after onset were prospectively enrolled, and their blood glucose levels were monitored every 15 minutes for 72-hour period using the FreeStyle Libre Pro. Multivariate logistic regression analyses were used to analyze potential predictors for hyperglycemic (>180 mg/dL) and hypoglycemic (<60 mg/dL) events.
A total of 39 acute ischemic stroke patients (mean age 75.9 ± 11.5 years) were enrolled, and CGM was started from 58.6 ± 41.9 hours after stroke onset. CGM showed hypoglycemic events in 19 patients and hyperglycemic events in 21 patients, and the frequencies of hypo- and hyperglycemic events during CGM were 10.1 ± 15.7% and 11.9 ± 22.5%, respectively. Hypoglycemic events were mainly observed in the night-time in patients with normoglycemia at admission. Logistic regression analyses demonstrated significant associations between the blood glucose level at admission and hypo- and hyperglycemic events on CGM.
This study of CGM found that many stroke patients have blood glucose levels outside the recommended guideline range in the acute phase. Blood glucose level on admission may be used as a predictor for hypo- and hyperglycemic events after admission.
在急性缺血性脑卒中患者中，目前的指南建议将血糖水平维持在 140-180mg/dL 范围内，并密切监测以防止低血糖（<60mg/dL）。我们旨在通过连续血糖监测（CGM）评估血糖变异性，并证明血糖水平超出血糖管理建议范围的急性缺血性脑卒中患者的风险。
前瞻性纳入发病后 7 天内入院的缺血性脑卒中患者，使用 FreeStyle Libre Pro 每 15 分钟监测其血糖水平 72 小时。采用多变量逻辑回归分析来分析高血糖（>180mg/dL）和低血糖（<60mg/dL）事件的潜在预测因素。
共纳入 39 例急性缺血性脑卒中患者（平均年龄 75.9±11.5 岁），在发病后 58.6±41.9 小时开始 CGM。CGM 显示 19 例患者出现低血糖事件，21 例患者出现高血糖事件，CGM 期间低血糖和高血糖事件的频率分别为 10.1±15.7%和 11.9±22.5%。入院时血糖正常的患者，低血糖事件主要发生在夜间。逻辑回归分析表明，入院时的血糖水平与 CGM 上的低血糖和高血糖事件之间存在显著关联。
本项 CGM 研究发现，许多脑卒中患者在急性期血糖水平超出推荐的指南范围。入院时的血糖水平可作为入院后低血糖和高血糖事件的预测因素。
