RESULTS OF GLYCEMIC CONTROL AMONG SEVERE STROKE PATIENTS

Abstract

  Background: Hyperglycemia is a relatively common condition in stroke patients, whether they have diabetes or not, and it is associated with adverse outcomes. Achieving target blood glucose levels has a partial impact on the results, but it is not the sole determinant. Objectives: We assessed the result of glycemic control among severe stroke patients. Materials and methods: A prospective study was conducted in the Stroke Department, Can Tho Central General Hospital, from June 2020 to April 2022, with 72 severe stroke patients monitored the capillary blood glucose every 3 hours. Nineteen patients who had persistent hyperglycemia were controlled with continuous intravenous insulin. We determined the average blood glucose level for each patient, the time needed to reach the glycemic target range, the frequency of hypoglycemia, and the glycemic variability from all measured blood glucose concentration. R programming was used to analyze the data. Results: The average age of patients was 65.1±16.1. The percentage of ischemic stroke, accounting for 55.6%, was the highest, followed by cerebral hemorrhage at 34.7%, 1.4% of these patients was attributed to cerebral venous thrombosis. In admission, the median Glasgow score was 8 (IQR: 7-9), and the median modified Rankin score was 5 (IQR: 4-5). Enteral nutrition was the primary nutritional therapy. Among 53 severe strokes without persistent hyperglycemia, blood glucose levels fluctuated around the mean value of 143 mg/dL. In 19 patients with persistently elevated blood glucose concentration, the mean blood glucose levels preinfusion and post-insulin infusion were 299±117mg/dL and 165±43.2mg/dL, respectively; time to glycemic target was 8.25 hours (95% CI: 3.50-14.75 hours), the minimum was 3 hours, and the longest was 189 hours; 5.3% of these patients developed hypoglycemia, and 13.3% of persistent hyperglycemia patients did not obtain the target range. Conclusions: Blood glucose levels fluctuate within the target range among patients with nonhyperglycemia or non-persistent hyperglycemia. In patients with persistent hyperglycemia controlled with intravenous insulin, the mean blood glucose levels were achieved close to the upper limit of the glycemic target.