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From Roudebush VA Medical Center (Drs. Williams and Tierney); Department of Neurology (Drs. Williams, Espay, and Bruno), Indiana University School of Medicine; Regenstrief Institute for Health Care (Drs. Williams, Rotich, and Tierney); Department of Medicine (Drs. N. Fineberg, S. Fineberg, and Tierney, and R. Qi), Indiana University School of Medicine, Indianapolis; and Moi University Faculty for the Health Sciences (Dr. Rotich), Eldoret, Kenya.
Address correspondence and reprint requests to Dr. Linda S. Williams, Roudebush VAMC, HSR&D, 1481 West 10th Street, Indianapolis, IN 46202; e-mail: lwilliams{at}hsrd.va.iupui.edu
Background: Hyperglycemia at the time of acute ischemic stroke has been linked to worse outcome in both human and animal studies.
Objective: To describe the prevalence and severity of hyperglycemia on hospital admission among acute ischemic stroke patients, to examine the independent relationship of admission hyperglycemia to all-cause mortality, and to document the inpatient management of hyperglycemia.
Methods: Patients hospitalized with acute ischemic stroke at one hospital from July 1993 to June 1998 (n = 656) were identified. Demographic data, diagnoses, and blood glucose (BG) values were retrieved from the electronic medical record system. Admission stroke severity, fingerstick BG results, and new diabetes diagnoses were obtained by chart review. Hyperglycemia was defined as admitting random serum BG 
130 mg/dL. Hazard ratios (HR) for 30-day, 1-year, and 6-year mortality were calculated using multivariable Cox regression models.
Results: Hyperglycemia at admission to hospital was present in 40% of patients with acute stroke. Patients with hyperglycemia were more often women and more likely to have prior diagnoses of diabetes and heart failure. Almost all of these patients remained hyperglycemic during their hospital stay (mean BG = 206 mg/dL), and 43% received no inpatient hypoglycemic drugs. Hyperglycemic patients had longer hospital stay (7 vs 6 days, p = 0.015) and higher inpatient hospital charges ($6,611 vs $5,262, p < 0.001). Hyperglycemia independently increased the risk for death at 30 days (HR 1.87, p 
0.01), 1 year (HR 1.75, p 0.01), and 6 years after stroke (HR 1.41, p 0.01).
Conclusions: Admitting hyperglycemia was common among patients with acute ischemic stroke and was associated with increased short- and long-term mortality and with increased inpatient charges. Inpatient blood glucose management was suboptimal in this hospital. A trial of intensive treatment of hyperglycemia should be considered.
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|
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|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 J. S. Krinsley and R. L. Jones Cost Analysis of Intensive Glycemic Control in Critically Ill Adult Patients Chest, March 1, 2006; 129(3): 644 - 650. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Plank, J. Blaha, J. Cordingley, M. E. Wilinska, L. J. Chassin, C. Morgan, S. Squire, M. Haluzik, J. Kremen, S. Svacina, et al. Multicentric, Randomized, Controlled Trial to Evaluate Blood Glucose Control by the Model Predictive Control Algorithm Versus Routine Glucose Management Protocols in Intensive Care Unit Patients Diabetes Care, February 1, 2006; 29(2): 271 - 276. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. S. Williams Feeding Patients after Stroke: Who, When, and How Ann Intern Med, January 3, 2006; 144(1): 59 - 60. [Full Text] [PDF]
|
|
|
|
|
|
American Diabetes Association Standards of Medical Care in Diabetes-2006 Diabetes Care, January 1, 2006; 29(suppl_1): S4 - S42. [Full Text] [PDF]
|
|
|
|
|
|
R. Garg, A. Chaudhuri, F. Munschauer, and P. Dandona Hyperglycemia, Insulin, and Acute Ischemic Stroke: A Mechanistic Justification for a Trial of Insulin Infusion Therapy Stroke, January 1, 2006; 37(1): 267 - 273. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
Part 9: Adult Stroke Circulation, December 13, 2005; 112(24_suppl): IV-111 - IV-120. [Full Text] [PDF]
|
|
|
|
 |
|
 T. M Conner, K. R Flesner-Gurley, and J. C Barner Hyperglycemia in the Hospital Setting: The Case for Improved Control Among Non-Diabetics Ann. Pharmacother., March 1, 2005; 39(3): 492 - 501. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
American Diabetes Association Standards of Medical Care in Diabetes Diabetes Care, January 1, 2005; 28(suppl_1): S4 - S36. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
C. M. Cely, P. Arora, A. A. Quartin, D. H. Kett, and R. M. H. Schein Relationship of Baseline Glucose Homeostasis to Hyperglycemia During Medical Critical Illness Chest, September 1, 2004; 126(3): 879 - 887. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. T. Bloomgarden Inpatient Diabetes Control: Approaches to treatment Diabetes Care, September 1, 2004; 27(9): 2272 - 2277. [Full Text] [PDF]
|
|
|
|
|
|
J. S. Krinsley Effect of an Intensive Glucose Management Protocol on the Mortality of Critically Ill Adult Patients Mayo Clin. Proc., August 1, 2004; 79(8): 992 - 1000. [Abstract] [PDF]
|
|
|
|
|
|
R. Leigh, O. O. Zaidat, M. F. Suri, G. Lynch, S. Sundararajan, J. L. Sunshine, R. Tarr, W. Selman, D. M.D. Landis, and J. I. Suarez Predictors of Hyperacute Clinical Worsening in Ischemic Stroke Patients Receiving Thrombolytic Therapy Stroke, August 1, 2004; 35(8): 1903 - 1907. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. S Lewis, S. L Kane-Gill, M. B. Bobek, and J. F Dasta Intensive Insulin Therapy for Critically Ill Patients Ann. Pharmacother., July 1, 2004; 38(7): 1243 - 1251. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Kusaka, G. Kusaka, C. Zhou, M. Ishikawa, A. Nanda, D. N. Granger, J. H. Zhang, and J. Tang Role of AT1 receptors and NAD(P)H oxidase in diabetes-aggravated ischemic brain injury Am J Physiol Heart Circ Physiol, June 1, 2004; 286(6): H2442 - H2451. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Bruno, C. Saha, L. S. Williams, and R. Shankar IV insulin during acute cerebral infarction in diabetic patients Neurology, April 27, 2004; 62(8): 1441 - 1442. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Rosand, M. H. Eckman, K. A. Knudsen, D. E. Singer, and S. M. Greenberg The Effect of Warfarin and Intensity of Anticoagulation on Outcome of Intracerebral Hemorrhage Arch Intern Med, April 26, 2004; 164(8): 880 - 884. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Hein Management of Hyperglycemia in the Hospitalized Podiatric Medical Patient J Am Podiatr Med Assoc, March 1, 2004; 94(2): 135 - 148. [Abstract] [Full Text] [PDF]
|
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|
|
|
P. A. Goldberg, M. D. Siegel, R. S. Sherwin, J. I. Halickman, M. Lee, V. A. Bailey, S. L. Lee, J. D. Dziura, and S. E. Inzucchi Implementation of a Safe and Effective Insulin Infusion Protocol in a Medical Intensive Care Unit Diabetes Care, February 1, 2004; 27(2): 461 - 467. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Clement, S. S. Braithwaite, M. F. Magee, A. Ahmann, E. P. Smith, R. G. Schafer, and I. B. Hirsch Management of Diabetes and Hyperglycemia in Hospitals Diabetes Care, February 1, 2004; 27(2): 553 - 591. [Full Text] [PDF]
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S. Passero, G. Ciacci, and M. Ulivelli The influence of diabetes and hyperglycemia on clinical course after intracerebral hemorrhage Neurology, November 25, 2003; 61(10): 1351 - 1356. [Abstract] [Full Text] [PDF]
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|
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S. M. Dorhout Mees, G. W. van Dijk, A. Algra, D. R.J. Kempink, and G. J.E. Rinkel Glucose levels and outcome after subarachnoid hemorrhage Neurology, October 28, 2003; 61(8): 1132 - 1133. [Abstract] [Full Text] [PDF]
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 K. Martin, L. Carter, D. Ballunas, F. Sotoudeh, D. Moore, and J. Westerflield The Impact of Verbal Communication on Physician Prescribing Patterns in Hospitalized Patients With Diabetes The Diabetes Educator, September 1, 2003; 29(5): 827 - 836. [Abstract] [PDF]
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D.M. Bravata, N. Kim, J. Concato, and L.M. Brass Hyperglycaemia in patients with acute ischaemic stroke: how often do we screen for undiagnosed diabetes? QJM, July 1, 2003; 96(7): 491 - 497. [Abstract] [Full Text] [PDF]
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J. A. Krishnan, P. B. Parce, A. Martinez, G. B. Diette, and R. G. Brower Caloric Intake in Medical ICU Patients: Consistency of Care With Guidelines and Relationship to Clinical Outcomes Chest, July 1, 2003; 124(1): 297 - 305. [Abstract] [Full Text] [PDF]
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D. L. Trence, J. L. Kelly, and I. B. Hirsch The Rationale and Management of Hyperglycemia for In-Patients with Cardiovascular Disease: Time for Change J. Clin. Endocrinol. Metab., June 1, 2003; 88(6): 2430 - 2437. [Abstract] [Full Text] [PDF]
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