Range of glucose as a glycemic variability and 3-month outcome in diabetic patients with acute ischemic stroke

• Published in: PloS one 2017-09, Vol.12 (9), p.e0183894-e0183894
• Main Authors: Kim, Young Seo, Kim, Chulho, Jung, Keun-Hwa, Kwon, Hyung-Min, Heo, Sung Hyuk, Kim, Beom Joon, Kim, Young Dae, Kim, Jeong-Min, Lee, Seung-Hoon
• Format: Article
• Language: English
• Subjects: Aged; Analysis; Biology and Life Sciences; Blood Glucose - metabolism; Care and treatment; Clinical outcomes; Confidence intervals; Data collection; Development and progression; Diabetes; Diabetes mellitus; Diabetes Mellitus - blood; Diabetics; Fasting; Female; Glucose; Glycated Hemoglobin A - metabolism; Glycosylated hemoglobin; Health aspects; Hemoglobin; Humans; Hyperglycemia; Hypoglycemia; Hypoglycemia - complications; Insulin; Ischemia; Length of Stay; Logistic Models; Male; Medicine and Health Sciences; Middle Aged; Mortality; Multivariate Analysis; Neurology; Patient outcomes; Patients; Physical Sciences; Quartiles; Regression analysis; Risk factors; Stroke; Stroke - blood; Stroke - complications; Treatment Outcome; Variability
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0183894

Glycemic variability (GV) is reportedly a predictor for poor outcome in various clinical conditions. We aimed to assess whether GV during hospital admission is associated with poor outcomes in patients with acute ischemic stroke (AIS) and diabetes. We prospectively enrolled consecutive patients with AIS from the registry of 6 tertiary hospitals between January 2013 and December 2014. For the GV index, we used a glucose level range that was divided into 4 quartiles. Multivariable binary and ordinal logistic regression analyses were performed to determine the association between GV and the modified Rankin Scale score (3-6) at 3 months. We enrolled 1,504 patients with AIS and diabetes (mean age, 68.1 years; male, 57.2%), of which 35.1% had poor outcomes at 3 months. An increasing glucose range quartile was positively associated with initial neurologic severity and development of hypoglycemia during hospital admission. Multivariable analysis showed that the glucose level range quartile was associated with poor outcomes, even after adjusting for the number of glucose measurement and hypoglycemia (odds ratio [OR] Q2 vs. Q1: 1.50, 95% confidence interval [CI]: 1.02-2.18; OR Q3 vs. Q1: 2.01, 95% CI: 1.34-3.01; OR Q4 vs. Q1: 1.98, 95% CI: 1.22-3.23). These associations remained significant after dichotomization according to glycated hemoglobin levels at admission. An increasing glucose level range as a GV index during hospital admission was associated with poor functional outcomes at 3 months in patients with AIS and diabetes.