Preechasuk Lukana, Rilstone Siân, Tang Wen Xi, Man Jackie, Yang Mingming, Zhao Erica, Hoque Lily, Tuncay Elif, Wilding Peter, Godsland Ian, Halse Omid, Banerjee Soma, Oliver Nick, Hill Neil E
Department of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London, United Kingdom.
Siriraj Diabetes Center of Excellence, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand.
PLoS One. 2025 May 30;20(5):e0318456. doi: 10.1371/journal.pone.0318456. eCollection 2025.
Glycaemic variability has been associated with poor outcomes in critically ill patients. We aimed to study the association between glycaemic variability and functional outcome in patients with acute ischaemic stroke using continuous glucose monitoring to ensure all episodes of hyper- and hypoglycaemia were captured.
Participants with acute ischaemic stroke were enrolled and started blinded continuous glucose monitoring (Dexcom G6) between November 2020 and December 2022. Glucose data from the first 72 hours after admission were analysed. Patients were classified into 3 groups based on change in functional status (Modified Rankin Scale) between admission and discharge. These included (i) remained independent (RI); (ii) deteriorated to dependent (DD); and (iii) remained dependent (RD).
Data of 67 patients (mean±SD age 72.1 ± 14 years) were analysed; 19 participants had diabetes. The median (IQR) National Institutes of Health Stroke Scale (NIHSS) was 8 (3,14), and 34.3% received reperfusion therapy. The percentage of patients with RI, DD, and RD was 25.4, 55.2, 19.4%. Patients with DD had older age, higher rate of atrial fibrillation, systolic blood pressure, rate of in-hospital infection, NIHSS at admission and at 24 hours after reperfusion therapy compared to those RI. Continuous glucose monitoring was started at 38.4 (29.5,51) hours after stroke onset. Those with DD had higher mean glucose, %time above 180 mg/dL, and glucose standard deviation than the RI group at discharge. Multivariate analysis showed only an association between NIHSS at admission and deterioration in functional status.
In this pilot study, an association between glycaemic variability and functional deterioration after acute ischaemic stroke was not observed. Clinical Trial Registration numberNCT04521634.
血糖变异性与危重症患者的不良预后相关。我们旨在通过持续葡萄糖监测以确保捕捉到所有高血糖和低血糖发作，研究急性缺血性脑卒中患者血糖变异性与功能结局之间的关联。
纳入急性缺血性脑卒中患者，并于2020年11月至2022年12月开始进行盲法持续葡萄糖监测（德康G6）。分析入院后前72小时的血糖数据。根据入院和出院时功能状态的变化（改良Rankin量表）将患者分为3组。这些组包括：（i）仍保持独立（RI）；（ii）恶化至依赖（DD）；以及（iii）仍处于依赖状态（RD）。
分析了67例患者的数据（平均±标准差年龄72.1±14岁）；19名参与者患有糖尿病。美国国立卫生研究院卒中量表（NIHSS）的中位数（IQR）为8（3,14），34.3%的患者接受了再灌注治疗。RI、DD和RD患者的百分比分别为25.4%、55.2%、19.4%。与RI组相比，DD组患者年龄更大、房颤发生率更高、收缩压更高、院内感染率更高、入院时及再灌注治疗后24小时的NIHSS更高。卒中发作后38.4（29.5,51）小时开始进行持续葡萄糖监测。出院时，DD组患者的平均血糖、高于180mg/dL的时间百分比和血糖标准差均高于RI组。多因素分析显示仅入院时的NIHSS与功能状态恶化之间存在关联。
在这项初步研究中，未观察到急性缺血性脑卒中后血糖变异性与功能恶化之间的关联。临床试验注册号NCT04521634。
