149 results match your criteria Metabolic Disease and Stroke - Hyperglycemia Hypoglycemia


Admission glucose level was associated with increased short-term mortality and length-of-stay irrespective of diagnosis, treating medical specialty or concomitant laboratory values.

Eur J Intern Med 2020 05 22;75:71-78. Epub 2020 Jan 22.

Department of Clinical Sciences, Endocrinology and Diabetes, Lund University, Lund, Sweden; Department of Internal Medicine, Endocrinology and Diabetes, Central Hospital, Region Kronoberg, Växjö, Sweden; Department of Research and Development, Region Kronoberg, Växjö, Sweden. Electronic address:

Background: Glucose is a routine emergency sample. General guidelines for inpatient hyperglycemia are scarce, except in myocardial infarction, stroke, and perioperative/ICU. Previous studies found admission glucose associated with increased mortality in specific conditions. Read More

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Insulin in the Management of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

World Neurosurg 2020 Apr 16;136:e514-e534. Epub 2020 Jan 16.

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address:

Objective: The role of tight glycemic control in the management of acute ischemic stroke remains uncertain. Our goal is to evaluate the effects of tight glucose control with insulin therapy after acute ischemic stroke.

Methods: We searched PubMed, CENTRAL, and Embase for randomized controlled trials (RCTs) that evaluated the effects of tight glycemic control (70-135 mg/dL) in acute ischemic stroke. Read More

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Intensive Versus Standard Glucose Control in Patients with Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials.

World Neurosurg 2020 Apr 16;136:e487-e495. Epub 2020 Jan 16.

Department of Neurology, Jining First People's Hospital, Jining, China. Electronic address:

Background: Hyperglycemia is common in patients with ischemic stroke (IS) and has been proven to be associated with worse clinical outcomes. However, it is controversial whether intensive glucose control (IGC) is superior to standard glucose control (SGC). Therefore, we carried out this meta-analysis based on randomized controlled trials (RCTs). Read More

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Glyco-metabolic control, inflammation markers, and cardiovascular outcomes in type 1 and type 2 diabetic patients on insulin pump or multiple daily injection (italico study).

Diabetes Metab Res Rev 2020 01 15;36(1):e3219. Epub 2019 Nov 15.

Centre of Diabetes and Metabolic Diseases, Department of Internal Medicine and Therapeutics, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Background: To evaluate if the positive effects recorded on glycaemic control with continuous subcutaneous insulin infusion (CSII) were maintained on the long-term compared with multiple daily injection (MDI). The secondary objective was to evaluate if there is a reduction of type and number of cardiovascular events (CV).

Methods: This retrospective, observational study evaluated glycaemic control and the number of CV in 104 patients with type 1 or 2 diabetes previously treated with MDI and initiating CSII therapy with tubed insulin pumps compared with 109 patients previously treated with MDI continuing MDI. Read More

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January 2020

Risk of Hyperglycemia and Hypoglycemia in Patients with Acute Ischemic Stroke Based on Continuous Glucose Monitoring.

J Stroke Cerebrovasc Dis 2019 Dec 21;28(12):104346. Epub 2019 Sep 21.

Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, Kanagawa, Japan.

Background: In patients with acute ischemic stroke, current guidelines recommend maintaining blood glucose levels in a range of 140-180 mg/dL and closely monitoring to prevent hypoglycemia (<60 mg/dL). We aimed to assess glucose variability by continuous glucose monitoring (CGM) and to demonstrate the risk of acute ischemic stroke patients with glucose levels outside of the glucose management recommendations.

Methods: Patients with ischemic stroke admitted within 7 days after onset were prospectively enrolled, and their blood glucose levels were monitored every 15 minutes for 72-hour period using the FreeStyle Libre Pro. Read More

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December 2019

Prehospital exenatide in hyperglycemic stroke-A randomized trial.

Acta Neurol Scand 2019 Dec 2;140(6):443-448. Epub 2019 Oct 2.

Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.

Objectives: Hyperglycemia is a predictor for poor stroke outcome. Hyperglycemic stroke patients treated with thrombolysis have an increased risk of intracranial hemorrhage. Insulin is the gold standard for treating hyperglycemia but comes with a risk of hypoglycemia. Read More

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December 2019

Glycemia management in acute ischemic stroke: current concepts and novel therapeutic targets.

Postgrad Med 2019 Sep 12;131(7):423-437. Epub 2019 Aug 12.

Second Department of Neurology, "Attikon" University Hospital, National and Kapodistrian University of Athens , Athens , Greece.

Hyperglycemia on hospital admission is a common phenomenon in acute ischemic stroke patients and represents an independent predictor of poor clinical outcome with or without acute recanalization therapies (systemic thrombolysis or mechanical thrombectomy). Effective restoration of normoglycemia is considered to be beneficial, but conclusive evidence from randomized controlled clinical trials and specific recommendations are lacking. In addition, aggressive glucose control can be complicated by hypoglycemia leading to early neurological deterioration. Read More

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September 2019

Hyperglycemia is associated with poor in-hospital outcome in elderly patients with acute ischemic stroke.

Medicine (Baltimore) 2019 Aug;98(31):e16723

Department of Endocrinology, Xuanwu Hospital of Capital Medical University, Beijing, China.

Fasting hyperglycemia is associated with poor neurologic outcome in acute ischemic stroke (AIS), but its relationship with in-hospital outcome in elderly patients remains largely unknown. To assess the association of in-hospital outcome with fasting plasma glucose (FPG) levels at admission in individuals with AIS.This retrospective propensity score-matched case-control study included patients aged over 60 years suffering from AIS and who were admitted to the emergency department from November 2013 to October 2016. Read More

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Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients With Acute Ischemic Stroke: The SHINE Randomized Clinical Trial.

JAMA 2019 07;322(4):326-335

Department of Public Health Sciences, Medical University of South Carolina, Charleston.

Importance: Hyperglycemia during acute ischemic stroke is common and is associated with worse outcomes. The efficacy of intensive treatment of hyperglycemia in this setting remains unknown.

Objectives: To determine the efficacy of intensive treatment of hyperglycemia during acute ischemic stroke. Read More

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The use of GLP-1 receptor agonists in hospitalised patients: An untapped potential.

Diabetes Metab Res Rev 2019 11 28;35(8):e3191. Epub 2019 Jun 28.

Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK.

In the outpatient setting, glucagon-like peptide-1 (GLP-1) receptor agonists have proved to be highly efficacious drugs that provide glycaemic control with a low risk of hypoglycaemia. These characteristics make GLP-1 receptor agonists attractive agents to treat dysglycaemia in perioperative or high-dependency hospital settings, where glycaemic variability and hyperglycaemia are associated with poor prognosis. GLP-1 also has a direct action on the myocardium and vasculature-which may be advantageous in the immediate aftermath of a vascular insult. Read More

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November 2019

Cognitive Dysfunction in Type 1 Diabetes Mellitus.

J Clin Endocrinol Metab 2019 06;104(6):2239-2249

Department of Hypertension and Diabetology, Medical University of Gdańsk, Faculty of Medicine, Gdańsk, Poland.

Context: We have summarized key studies assessing the epidemiology, mechanisms, and consequences of cognitive dysfunction (CD) in type 1 diabetes.

Evidence Synthesis: In a number of studies, the severity of CD in type 1 diabetes was affected by the age of onset and duration, and the presence of proliferative retinopathy and autonomic neuropathy. Diabetes-related CD has been observed, not only in adults, but also in children and adolescents. Read More

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All-cause mortality of insulin plus dipeptidyl peptidase-4 inhibitors in persons with type 2 diabetes.

BMC Endocr Disord 2019 Jan 5;19(1). Epub 2019 Jan 5.

Institute of Population Health Sciences, National Health Research Institutes, No.35, Keyan Road, Zhunan Township, Miaoli County, 35053, Taiwan.

Background: Dipeptidyl peptidase-4 (DPP-4) inhibitors could effectively reduce HbA and postprandial hyperglycemia and could incur only minimal danger of hypoglycemia. Patients with uncontrolled diabetes might be treated by the complementary action of insulin plus DPP-4 inhibitors. Here, we compared the all-cause mortality risk between DPP-4 inhibitor users and nonusers with underlying insulin therapy. Read More

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January 2019

Impact of Relative Blood Glucose Changes on Mortality Risk of Patient with Acute Ischemic Stroke and Treated with Mechanical Thrombectomy.

J Stroke Cerebrovasc Dis 2019 Jan 24;28(1):213-219. Epub 2018 Oct 24.

Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China. Electronic address:

Background And Purpose: The impacts of stress hyperglycemia and hypoglycemia on mortality of acute ischemic stroke patients treated with mechanical thrombectomy (MT) are largely unclear. This study aimed to use stress hyperglycemia ratio (SHR) to evaluate the influence of pretreatment relative blood glucose changes on mortality risk after MT.

Methods: The study retrospectively enrolled 321 acute ischemic stroke patients treated with MT. Read More

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January 2019

[Impact of Glycemic Variability on Cardiovascular Risk in Diabetes].

Authors:
V V Klimontov

Kardiologiia 2018 Oct(10):80-87

Scientific Institute of Clinical and Experimental Lymphology.

A growing body of evidences indicates the role of increased glucose variability (GV) as an independent cardiovascular risk factor in diabetes. It has been shown that high GV is associated with coronary and carotid atherosclerosis in diabetic subjects. The impact of enhanced glycemic fluctuations on vascular wall is mediated through non-enzymatic glycation, oxidative stress, activation of inflammatory pathways, and endothelial dysfunction. Read More

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October 2018

Early Glycemic Profile Is Associated with Brain Injury Patterns on Magnetic Resonance Imaging in Hypoxic Ischemic Encephalopathy.

J Pediatr 2018 12 6;203:137-143. Epub 2018 Sep 6.

Division of Neonatology, Children's National Health System, Washington, DC; Fetal Medicine Institute, Children's National Health System, Washington, DC. Electronic address:

Objective: To investigate whether the early glycemic profile in infants with hypoxic ischemic encephalopathy is associated with distinct patterns of brain injury on magnetic resonance imaging (MRI).

Study Design: We performed a secondary analysis of 178 prospectively enrolled infants who received therapeutic hypothermia for hypoxic ischemic encephalopathy. Glycemic profiles were identified by glucose concentrations within 24 hours after birth: normoglycemia (all glucose concentrations of >47 to ≤150 mg/dL; n = 62); hypoglycemia (≥1 concentration ≤47 mg/dL; n = 17); hyperglycemia (≥1 concentration >150 mg/dL; n = 76); and labile glucose (both hypoglycemia and hyperglycemia; n = 23). Read More

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December 2018

Treatment with exenatide in acute ischemic stroke trial protocol: A prospective, randomized, open label, blinded end-point study of exenatide vs. standard care in post stroke hyperglycemia.

Int J Stroke 2018 10 18;13(8):857-862. Epub 2018 Jul 18.

1 Monash University Eastern Health Clinical School, Melbourne, VIC, Australia.

Rationale Post-stroke hyperglycemia occurs in up to 50% of patients presenting with acute ischemic stroke. It reduces the efficacy of thrombolysis, increases infarct size, and worsens clinical outcomes. Insulin-based therapies have generally not been beneficial in treating post-stroke hyperglycemia as they are difficult to implement, may cause hypoglycaemia, possibly increase mortality and worsen clinical outcomes. Read More

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October 2018

Inpatient Glycemic Management of Non-cardiac CVD: Focus on Stroke and PVD.

Curr Diab Rep 2018 06 16;18(8):49. Epub 2018 Jun 16.

Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 333, Baltimore, MD, 21287, USA.

Purpose Of Review: Hyperglycemia occurs frequently in hospitalized patients with stroke and peripheral vascular disease (PVD). Guidelines for inpatient glycemic management are not well established for this patient population. We will review the clinical impact of hyperglycemia in this acute setting and review the evidence for glycemic control. Read More

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Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring.

J Am Heart Assoc 2018 04 12;7(8). Epub 2018 Apr 12.

Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.

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. Read More

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Diabetes and cardiovascular disease: from new mechanisms to new therapies.

Authors:
Grzegorz Gajos

Pol Arch Intern Med 2018 03 26;128(3):178-186. Epub 2018 Mar 26.

Diabetes increases the risk of cardiovascular diseases, which are the leading cause of mortality among diabetic patients. Although hyperglycemia is a major determinant of macrovascular and microvascular complications in diabetes, hypoglycemia and glycemic variability have also a strong influence on the cardiovascular system. This overview presents the current state of knowledge on the impact of type 2 diabetes on the cardiovascular system and new therapeutic strategies that have been recently developed to correct gluco-metabolic disturbances in patients with high cardiovascular risk, such as glucagon-like peptide-1 (GLP-1) receptor agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose cotransporter 2 (SGLT2) inhibitors. Read More

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2018 consensus of the Taiwan Society of Cardiology and the Diabetes Association of Republic of China (Taiwan) on the pharmacological management of patients with type 2 diabetes and cardiovascular diseases.

J Chin Med Assoc 2018 03 13;81(3):189-222. Epub 2018 Feb 13.

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC. Electronic address:

The global incidence and prevalence of type 2 diabetes have been escalating in recent decades. Patients with type 2 diabetes have an increased risk of atherosclerotic cardiovascular disease (ASCVD). About two-thirds of death in type 2 diabetes are due to ASCVD, including 40% from coronary heart disease (CHD), 15% from heart failure (HF), and 10% from stroke. Read More

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Diabetes in the older patient: heterogeneity requires individualisation of therapeutic strategies.

Diabetologia 2018 07 7;61(7):1503-1516. Epub 2018 Feb 7.

Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel, 18-20 1090, Vienna, Austria.

Owing to the worldwide increase in life expectancy, the high incidence of diabetes in older individuals and the improved survival of people with diabetes, about one-third of all individuals with diabetes are now older than 65 years. Evidence is accumulating that type 2 diabetes is associated with cognitive impairment, dementia and frailty. Older people with diabetes have significantly more comorbidities, such as myocardial infarction, stroke, peripheral arterial disease and renal impairment, compared with those without diabetes. Read More

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Macrovascular Complications in Patients with Diabetes and Prediabetes.

Biomed Res Int 2017 7;2017:7839101. Epub 2017 Nov 7.

Department of Medicine and Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.

Diabetes is a significant health problem worldwide, and its association with cardiovascular disease (CVD) was reported in several studies. Hyperglycemia and insulin resistance seen in diabetes and prediabetes lead to an increase in reactive oxygen species, which triggers intracellular molecular signaling. The resulting prothrombotic state and increase in inflammatory mediators expedite atherosclerotic changes and the development of macrovascular complications. Read More

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Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus.

Cochrane Database Syst Rev 2017 12 4;12:CD003054. Epub 2017 Dec 4.

Department of Internal Medicine, Herlev University Hospital, Herlev Ringvej 75, Herlev, Denmark, DK-2730.

Background: The projected rise in the incidence of type 2 diabetes mellitus (T2DM) could develop into a substantial health problem worldwide. Whether diet, physical activity or both can prevent or delay T2DM and its associated complications in at-risk people is unknown.

Objectives: To assess the effects of diet, physical activity or both on the prevention or delay of T2DM and its associated complications in people at increased risk of developing T2DM. Read More

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December 2017

The value of real-time continuous glucose monitoring in premature infants of diabetic mothers.

PLoS One 2017 16;12(10):e0186486. Epub 2017 Oct 16.

Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.

To determine the feasibility of using a real-time continuous glucose monitoring system (RTGMS) in intensive care units, our study focus on preterm infants with diabetic mothers owing to their high risk of blood sugar abnormalities. Thirty preterm babies (M = 15 and F = 15; ≤ 36 week gestation age) were studied from within 72 hours of delivery. These babies were admitted to the newborn intensive care and were further categorized into groups based on whether their mothers with or without diabetic mellitus. Read More

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November 2017

Dapagliflozin is associated with lower risk of cardiovascular events and all-cause mortality in people with type 2 diabetes (CVD-REAL Nordic) when compared with dipeptidyl peptidase-4 inhibitor therapy: A multinational observational study.

Diabetes Obes Metab 2018 02 8;20(2):344-351. Epub 2017 Sep 8.

Oslo University Hospital, Oslo, Norway.

Aims: To compare the sodium-glucose-cotransporter-2 (SGLT-2) inhibitor dapagliflozin with dipeptidyl peptidase-4 (DPP-4) inhibitors with regard to risk associations with major adverse cardiovascular (CV) events (MACE; non-fatal myocardial infarction, non-fatal stroke or cardiovascular mortality), hospitalization for heart failure (HHF), atrial fibrillation and severe hypoglycaemia in patients with type 2 diabetes (T2D) in a real-world setting.

Methods: All patients with T2D prescribed glucose-lowering drugs (GLDs) during 2012 to 2015 were identified in nationwide registries in Denmark, Norway and Sweden. Patients were divided into two groups: new users of dapagliflozin and new users of DPP-4 inhibitors, matched 1:3 by propensity score, calculated by patient characteristics, comorbidities and drug treatment. Read More

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February 2018

[Safety and tolerability of oral hypoglycemic therapies in type 2 diabetes mellitus patients at high cardiovascular risk].

G Ital Cardiol (Rome) 2017 Jun;18(6):485-495

Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli.

Oral hypoglycemic drugs for type 2 diabetes aim at preventing the metabolic effects of hyperglycemia and cardiovascular (CV) events. The evidence of the possible CV risk related to the prescription of some antidiabetic drugs prompted regulatory agencies to require safety studies. This review provides an updated analysis of CV safety profiles for antidiabetic drugs used for the treatment of patients with high CV risk. Read More

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Cerebral ischemic damage in diabetes: an inflammatory perspective.

J Neuroinflammation 2017 01 23;14(1):21. Epub 2017 Jan 23.

Cerebral Vascular Disease Research Laboratories, University of Miami School of Medicine, Miami, FL, 33136, USA.

Stroke is one of the leading causes of death worldwide. A strong inflammatory response characterized by activation and release of cytokines, chemokines, adhesion molecules, and proteolytic enzymes contributes to brain damage following stroke. Stroke outcomes are worse among diabetics, resulting in increased mortality and disabilities. Read More

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January 2017

Relationship of glycated haemoglobin and reported hypoglycaemia to cardiovascular outcomes in patients with type 2 diabetes and recent acute coronary syndrome events: The EXAMINE trial.

Diabetes Obes Metab 2017 05 27;19(5):664-671. Epub 2017 Feb 27.

Harvard Clinical Research Institute, Boston, Massachusetts.

Aims: To investigate relationships between glycated haemoglobin (HbA1c) and reported hypoglycaemia and risk of major adverse cardiovascular events (MACE).

Methods: The EXAMINE trial randomized 5380 patients with type 2 diabetes (T2DM) and a recent acute coronary syndrome (ACS) event, in 49 countries, to double-blind treatment with alogliptin or placebo in addition to standard of care. We used Cox proportional hazards models to analyse relationships among MACE, HbA1c levels and hypoglycaemic events. Read More

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Managing glycaemia in older people with type 2 diabetes: A retrospective, primary care-based cohort study, with economic assessment of patient outcomes.

Diabetes Obes Metab 2017 05 23;19(5):644-653. Epub 2017 Feb 23.

Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Worcester, UK.

Aims: To describe the relative health and economic outcomes associated with different second-line therapeutic approaches to manage glycaemia in older type 2 diabetes patients requiring escalation from metformin monotherapy.

Materials And Methods: The Clinical Practice Research Datalink database was used to inform a retrospective observational cohort study of patients with type 2 diabetes treated with metformin monotherapy requiring escalation (addition or switch) to a second-line oral regimen from January 1, 2008 to December 31, 2014. Primary outcomes included time to first event (any event, myocardial infarction [MI], stroke, or composite of MI/stroke [major adverse cardiovascular event; MACE]) and total event rate. Read More

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