Usefulness of glycated hemoglobin A1c-based adjusted glycemic variables in diabetic patients presenting with acute ischemic stroke - 21/08/17

Doi : 10.1016/j.ajem.2017.03.049

Chih-Jen Yang, MD ^a, Wen-I Liao, MD ^a, Jen-Chun Wang, MD ^a, Chia-Lin Tsai, MD ^b, Jiunn-Tay Lee, MD ^b, Giia-Sheun Peng, MD, PhD ^c, Chien-Hsing Lee, MD, PhD ^d, Chin-Wang Hsu, MD ^e,^f, Shih-Hung Tsai, MD, PhD ^a,^{^⁎}
^a Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
^b Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
^c Department of Neurology, Taipei Veteran's General Hospital, Hsinchu Branch, Hsinchu, Taiwan
^d Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
^e Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
^f Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

^⁎Corresponding author at: Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Taipei, Taiwan.Department of Emergency MedicineTri-Service General HospitalNational Defense Medical CenterNo. 325, Sec. 2, Cheng-Kung RoadTaipeiTaiwan

Abstract

Acute hyperglycemia is a common condition among patients with diabetes who are admitted to the emergency department (ED) for acute ischemic stroke (AIS). Previous findings regarding the association between hyperglycemia at admission and adverse outcomes among patients with diabetes and AIS have been inconsistent. When investigating this association, it is necessary to consider premorbid blood glucose control. The objective of the current study was to assess whether HbA1c-based adjusted glycemic variables were associated with unfavorable outcomes among patients admitted to the hospital for AIS. We retrospectively analyzed data from 309 patients who were hospitalized for AIS at a single medical center in Taiwan between January 1, 2013, and October 31, 2015. We found that 1) HbA1c-based adjusted glycemic variables, including the glycemic gap and stress hyperglycemia ratio, were associated with both AIS severity and neurological status at discharge; additionally, 2) HbA1c-based adjusted glycemic variables showed superior discriminative power compared with acute hyperglycemia regarding the development of severe AIS. We conclude that both the glycemic gap and stress hyperglycemia ratio might be useful in assessing the disease severity and prognosis of patients presenting with AIS. Further prospective long-term follow-up studies should be performed to validate these findings.

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Keywords : Acute ischemic stroke, Diabetes mellitus, Outcome assessment, Glycated hemoglobin, Hyperglycemia, glycemic gap, stress hyperglycemia ratio, stress-induced hyperglycemia

Plan

Introduction

Materials and methods

Patients

Methods

Determination of serum glucose levels, the HbA1c glycemic gap and stress hyperglycemia ratio

Statistical analyses

Results

Demographic data and clinical outcomes

Correlations between acute hyperglycemia, long-term blood glucose control, glycemic gap, stress hyperglycemia ratio, and AIS severity

Additional information

☆	The work was performed at Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

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Vol 35 - N° 9

P. 1240-1246 - septembre 2017 Retour au numéro

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Usefulness of glycated hemoglobin A1c-based adjusted glycemic variables in diabetic patients presenting with acute ischemic stroke - 21/08/17

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