The study conducted by the Endocrinology and Nutrition Services and the Neurology Department of Hospital del Mar, in collaboration with researchers from the hospital’s Research Institute, the RICORS-ICTUS network, and the CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), highlights a critical finding regarding ischemic stroke patients. Published in the journal Cardiovascular Diabetology, this research indicates that elevated blood sugar levels at the time of hospital admission significantly heighten the risk of adverse functional outcomes or death within three months post-stroke. This discovery underscores the need for further investigation to ascertain how this factor might be leveraged in clinical practice to improve patient care.
This study specifically examines the phenomenon of hyperglycemia, or high blood sugar levels, which is a common yet underexplored occurrence in ischemic stroke cases. The research delved into data from 2,774 patients, assessing not only their blood sugar levels upon admission but also various other critical factors like age, diabetes status, disability, stroke severity, and received treatments. The analysis confirmed that a blood glucose level exceeding the usual by just 13% is associated with a notably poorer prognosis, independent of other factors. This pattern holds even for patients with a history of diabetes, who constitute 35% of the study’s population.
Dr Elisenda Climent, an associate doctor at the Endocrinology and Nutrition Service of Hospital del Mar and a researcher at its Research Institute, notes that higher glucose levels at admission indicate worse outcomes. Specifically, for every 10% increase in blood sugar levels, the risk of a poorer prognosis escalates by 7%. These risks compound significantly in patients with the highest glucose levels, leading to a 62% increase in the risk of worse outcomes and an 88% increase in mortality risk.
The research team is keen to continue this inquiry to determine whether actively managing glucose levels could offer clinical benefits. Currently, due to the risks associated with rapid glucose reduction, a conservative approach is preferred in controlling sugar levels in stroke patients. Dr Ana Rodríguez, head of the stroke section at the Neurology Service and a researcher at the Research Institute of Hospital del Mar, emphasizes that while strict glucose control strategies have not demonstrated clear advantages and carry significant risks, the findings from this study might enable targeted, intensive interventions for specific patient groups using advanced monitoring technologies.
Future studies, as outlined by Dr Juan José Chillarón, head of the Endocrinology and Nutrition Service, and Joan Jiménez Balado, a researcher from the Research Institute, will explore whether elevated glucose levels merely act as a marker of severity or if they are actionable targets that can substantially enhance patient outcomes. The goal is to determine whether more aggressive insulin therapy could be safely administered to a targeted subgroup of patients, potentially shifting the paradigm in how ischemic stroke is treated regarding patient glucose levels.
More information: Elisenda Climent et al, Acute-to-chronic glycemic ratio as an outcome predictor in ischemic stroke in patients with and without diabetes mellitus, Cardiovascular Diabetology. DOI: 10.1186/s12933-024-02260-9
Journal information: Cardiovascular Diabetology Provided by IMIM Hospital del Mar Medical Research Institute
