Abnormal glucose regulation, hypoglycemic treatment during hospitalization and prognosis of acute ischemic stroke

Abstract

Background: To examine the effect of abnormal glucose regulation on prognosis and whether hypoglycemic treatment during hospitalization improves prognosis in acute ischemic stroke patients.

Methods: A total of 3882 acute ischemic stroke patients with an elevated systolic blood pressure between 140mmHg and 220mmHg were included in the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). The primary outcome was a combination of death and major disability (modified Rankin Scale score≥3) at 3months after stroke. Secondary outcomes included death, major disability, and vascular events.

Results: Compared with normal fasting plasma glucose, odds ratios (95% confidence interval) associated with impaired fasting glucose (IFG) and diabetes mellitus (DM) were 1.25 (0.92-1.68) and 1.38 (1.13-1.67) for composite outcome of death or major disability, respectively, and there was a significant trend for death or major disability (P_trend=0.001). A linear association between fasting plasma glucose and the risk of combined outcome of death and major disability was observed among the patients without hypoglycemic treatment during hospitalization (P for linearity=0.005). We found protective effect of hypoglycemic treatment for risk of death (odds ratio, 0.47; 95% confidence interval, 0.24-0.92) among ischemic stroke patients with DM.

Conclusions: Abnormal glucose regulation, especially DM, increased risks of 3-month poor outcomes after an acute ischemic stroke and hypoglycemic treatment during hospitalization might improve prognosis in ischemic stroke patients with DM.

Keywords: Glucose; Hypoglycemic treatment; Prognosis; Stroke.