Outcome prediction in acute stroke patients by continuous glucose monitoring

Shinichi Wada, Sohei Yoshimura, Manabu Inoue, Takayuki Matsuki, Shoji Arihiro, Masatoshi Koga, Takanari Kitazono, Hisashi Makino, Kiminori Hosoda, Masafumi Ihara, Kazunori Toyoda

Research output: Contribution to journalArticle

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Abstract

Background--The purpose of this study was to examine the relationships between glucose parameters obtained by continuous glucose monitoring and clinical outcomes in acute stroke patients. Methods and Results--Consecutive patients with acute ischemic stroke or intracerebral hemorrhage within 24 hours after onset were included. A continuous glucose monitoring device (iPro2) was attached for the initial 72 hours after emergent admission. Eight glucose parameters were obtained from continuous glucose monitoring: maximum, minimum, mean, and SD of blood glucose levels, as well as area under the curve more than 8 mmol/L of blood glucose, distribution time more than 8 mmol/L of blood glucose, coefficient of variation (%CV), and presence of time less than 4 mmol/L over 72 hours. The primary outcome measure was death or dependency at 3 months (modified Rankin Scale score ≥3). One hundred patients with acute ischemic stroke (n=58) or intracerebral hemorrhage (n=42) were included. Blood glucose levels varied between 5.2±1.4 and 11.4±3.2 mmol/L over 72 hours, with area under the curve more than 8 mmol/L of blood glucose of 0.7±1.4 min9mmol/L, distribution time more than 8 mmol/L of blood glucose of 31.7±32.7%, coefficient of variation of 15.5±5.4%, and presence of hypoglycemia in 20% of overall patients. Mean glucose level (adjusted odds ratio, 1.60, 95% confidence interval, 1.12-2.28/1 mmol/L), area under the curve more than 8 mmol/L of blood glucose (2.13, 1.12-4.02/1 min×mmol/L), and distribution time more than 8 mmol/L of blood glucose (1.25, 1.05-1.50/10%) were related to death or dependency for overall patients, as well as for acute ischemic stroke patients (2.05, 1.15-3.65; 2.38, 1.04-5.44; 1.85, 1.10-3.10, respectively). Conclusions--High mean glucose levels, distribution time more than 8 mmol/L of blood glucose, and areas under the curve more than 8 mmol/L of blood glucose during the initial 72 hours of acute stroke were associated with death or dependency at 3 months.

Original languageEnglish
Article numbere008744
JournalJournal of the American Heart Association
Volume7
Issue number8
DOIs
Publication statusPublished - Apr 17 2018

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Blood Glucose
Stroke
Glucose
Area Under Curve
Cerebral Hemorrhage
Hypoglycemia
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals
Equipment and Supplies

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Wada, S., Yoshimura, S., Inoue, M., Matsuki, T., Arihiro, S., Koga, M., ... Toyoda, K. (2018). Outcome prediction in acute stroke patients by continuous glucose monitoring. Journal of the American Heart Association, 7(8), [e008744]. https://doi.org/10.1161/JAHA.118.008744

Outcome prediction in acute stroke patients by continuous glucose monitoring. / Wada, Shinichi; Yoshimura, Sohei; Inoue, Manabu; Matsuki, Takayuki; Arihiro, Shoji; Koga, Masatoshi; Kitazono, Takanari; Makino, Hisashi; Hosoda, Kiminori; Ihara, Masafumi; Toyoda, Kazunori.

In: Journal of the American Heart Association, Vol. 7, No. 8, e008744, 17.04.2018.

Research output: Contribution to journalArticle

Wada, S, Yoshimura, S, Inoue, M, Matsuki, T, Arihiro, S, Koga, M, Kitazono, T, Makino, H, Hosoda, K, Ihara, M & Toyoda, K 2018, 'Outcome prediction in acute stroke patients by continuous glucose monitoring', Journal of the American Heart Association, vol. 7, no. 8, e008744. https://doi.org/10.1161/JAHA.118.008744
Wada, Shinichi ; Yoshimura, Sohei ; Inoue, Manabu ; Matsuki, Takayuki ; Arihiro, Shoji ; Koga, Masatoshi ; Kitazono, Takanari ; Makino, Hisashi ; Hosoda, Kiminori ; Ihara, Masafumi ; Toyoda, Kazunori. / Outcome prediction in acute stroke patients by continuous glucose monitoring. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 8.
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abstract = "Background--The purpose of this study was to examine the relationships between glucose parameters obtained by continuous glucose monitoring and clinical outcomes in acute stroke patients. Methods and Results--Consecutive patients with acute ischemic stroke or intracerebral hemorrhage within 24 hours after onset were included. A continuous glucose monitoring device (iPro2) was attached for the initial 72 hours after emergent admission. Eight glucose parameters were obtained from continuous glucose monitoring: maximum, minimum, mean, and SD of blood glucose levels, as well as area under the curve more than 8 mmol/L of blood glucose, distribution time more than 8 mmol/L of blood glucose, coefficient of variation ({\%}CV), and presence of time less than 4 mmol/L over 72 hours. The primary outcome measure was death or dependency at 3 months (modified Rankin Scale score ≥3). One hundred patients with acute ischemic stroke (n=58) or intracerebral hemorrhage (n=42) were included. Blood glucose levels varied between 5.2±1.4 and 11.4±3.2 mmol/L over 72 hours, with area under the curve more than 8 mmol/L of blood glucose of 0.7±1.4 min9mmol/L, distribution time more than 8 mmol/L of blood glucose of 31.7±32.7{\%}, coefficient of variation of 15.5±5.4{\%}, and presence of hypoglycemia in 20{\%} of overall patients. Mean glucose level (adjusted odds ratio, 1.60, 95{\%} confidence interval, 1.12-2.28/1 mmol/L), area under the curve more than 8 mmol/L of blood glucose (2.13, 1.12-4.02/1 min×mmol/L), and distribution time more than 8 mmol/L of blood glucose (1.25, 1.05-1.50/10{\%}) were related to death or dependency for overall patients, as well as for acute ischemic stroke patients (2.05, 1.15-3.65; 2.38, 1.04-5.44; 1.85, 1.10-3.10, respectively). Conclusions--High mean glucose levels, distribution time more than 8 mmol/L of blood glucose, and areas under the curve more than 8 mmol/L of blood glucose during the initial 72 hours of acute stroke were associated with death or dependency at 3 months.",
author = "Shinichi Wada and Sohei Yoshimura and Manabu Inoue and Takayuki Matsuki and Shoji Arihiro and Masatoshi Koga and Takanari Kitazono and Hisashi Makino and Kiminori Hosoda and Masafumi Ihara and Kazunori Toyoda",
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AU - Yoshimura, Sohei

AU - Inoue, Manabu

AU - Matsuki, Takayuki

AU - Arihiro, Shoji

AU - Koga, Masatoshi

AU - Kitazono, Takanari

AU - Makino, Hisashi

AU - Hosoda, Kiminori

AU - Ihara, Masafumi

AU - Toyoda, Kazunori

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N2 - Background--The purpose of this study was to examine the relationships between glucose parameters obtained by continuous glucose monitoring and clinical outcomes in acute stroke patients. Methods and Results--Consecutive patients with acute ischemic stroke or intracerebral hemorrhage within 24 hours after onset were included. A continuous glucose monitoring device (iPro2) was attached for the initial 72 hours after emergent admission. Eight glucose parameters were obtained from continuous glucose monitoring: maximum, minimum, mean, and SD of blood glucose levels, as well as area under the curve more than 8 mmol/L of blood glucose, distribution time more than 8 mmol/L of blood glucose, coefficient of variation (%CV), and presence of time less than 4 mmol/L over 72 hours. The primary outcome measure was death or dependency at 3 months (modified Rankin Scale score ≥3). One hundred patients with acute ischemic stroke (n=58) or intracerebral hemorrhage (n=42) were included. Blood glucose levels varied between 5.2±1.4 and 11.4±3.2 mmol/L over 72 hours, with area under the curve more than 8 mmol/L of blood glucose of 0.7±1.4 min9mmol/L, distribution time more than 8 mmol/L of blood glucose of 31.7±32.7%, coefficient of variation of 15.5±5.4%, and presence of hypoglycemia in 20% of overall patients. Mean glucose level (adjusted odds ratio, 1.60, 95% confidence interval, 1.12-2.28/1 mmol/L), area under the curve more than 8 mmol/L of blood glucose (2.13, 1.12-4.02/1 min×mmol/L), and distribution time more than 8 mmol/L of blood glucose (1.25, 1.05-1.50/10%) were related to death or dependency for overall patients, as well as for acute ischemic stroke patients (2.05, 1.15-3.65; 2.38, 1.04-5.44; 1.85, 1.10-3.10, respectively). Conclusions--High mean glucose levels, distribution time more than 8 mmol/L of blood glucose, and areas under the curve more than 8 mmol/L of blood glucose during the initial 72 hours of acute stroke were associated with death or dependency at 3 months.

AB - Background--The purpose of this study was to examine the relationships between glucose parameters obtained by continuous glucose monitoring and clinical outcomes in acute stroke patients. Methods and Results--Consecutive patients with acute ischemic stroke or intracerebral hemorrhage within 24 hours after onset were included. A continuous glucose monitoring device (iPro2) was attached for the initial 72 hours after emergent admission. Eight glucose parameters were obtained from continuous glucose monitoring: maximum, minimum, mean, and SD of blood glucose levels, as well as area under the curve more than 8 mmol/L of blood glucose, distribution time more than 8 mmol/L of blood glucose, coefficient of variation (%CV), and presence of time less than 4 mmol/L over 72 hours. The primary outcome measure was death or dependency at 3 months (modified Rankin Scale score ≥3). One hundred patients with acute ischemic stroke (n=58) or intracerebral hemorrhage (n=42) were included. Blood glucose levels varied between 5.2±1.4 and 11.4±3.2 mmol/L over 72 hours, with area under the curve more than 8 mmol/L of blood glucose of 0.7±1.4 min9mmol/L, distribution time more than 8 mmol/L of blood glucose of 31.7±32.7%, coefficient of variation of 15.5±5.4%, and presence of hypoglycemia in 20% of overall patients. Mean glucose level (adjusted odds ratio, 1.60, 95% confidence interval, 1.12-2.28/1 mmol/L), area under the curve more than 8 mmol/L of blood glucose (2.13, 1.12-4.02/1 min×mmol/L), and distribution time more than 8 mmol/L of blood glucose (1.25, 1.05-1.50/10%) were related to death or dependency for overall patients, as well as for acute ischemic stroke patients (2.05, 1.15-3.65; 2.38, 1.04-5.44; 1.85, 1.10-3.10, respectively). Conclusions--High mean glucose levels, distribution time more than 8 mmol/L of blood glucose, and areas under the curve more than 8 mmol/L of blood glucose during the initial 72 hours of acute stroke were associated with death or dependency at 3 months.

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