Relationship Between Daily Blood Glucose Variability and Neurological Outcome in Acute Ischemic Stroke Patients With Diabetes Mellitus

BACKGROUND: Although hyperglycemia in acute stroke is associated with poor stroke outcomes, it remains unclear whether blood glucose variability are also associated with stroke outcomes. In this study, we examined the relationships between daily blood glucose variability and early neurological outcome in acute ischemic stroke patients with diabetes mellitus.METHODS: Subjects were a total of 329 acute ischemic stroke patients (216 male, 70.9 ± 9.6 years) who were either already undergoing treatment for diabetes or had a hemoglobin A1c level of u003e5.8% at admission from July 2006 to June 2009. The consecutive morning fasting blood glucose (BG) levels were evaluated during 7 days from admission and described as mean and successive variation (SV). The unfavorable outcome was defined by a modified Rankin Scale score of 4 to 6 at discharge.RESULTS: The patients with unfavorable outcome (n=86) were older (75.7 ± 10.5 vs. 69.2 ± 8.6 years, pu003c0.001), more frequently female (47.7% vs. 29.6%, p=0.003), less commonly had dyslipidemia (40.7% vs. 60.9%, p=0.001), less commonly took oral hypoglycemic agents (30.2% vs. 53.5%, pu003c0.001), and had higher NIHSS scores (median 9 vs. 3, pu003c0.001) than those without. The mean BG levels and SV levels in patients with unfavorable outcome were higher than those in patients without (163.3 ± 39.0 vs. 147.9 ± 34.0 mg/dl; pu003c0.001 and 33.7 ± 24.9 vs. 23.2 ± 15.3 mg/dl; pu003c0.001, respectively).SV levels was independently associated with unfavorable outcome (OR 1.023, 95%CI 1.004-1.042, p=0.015) using logistic regression analysis controlling age, sex hypertension systolic blood pressure, NIHSS score at admission and insulin use during hospitalization, which are selected using stepwise method.However mean BG levels did not remained as factor, which associated with unfavorable outcome with step wise method.CONCLUSION: Increased blood glucose variability, but not mean BG, was independently related to unfavorable outcome at discharge in acute ischemic stroke patients with diabetes mellitus.