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Pol Arch Intern Med 2018 Mar 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

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

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

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

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

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

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

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

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

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

J Diabetes Complications 2017 Feb 5;31(2):390-394. Epub 2016 Dec 5.

Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea. Electronic address:

Background And Purpose: The association between blood glucose fluctuation and poststroke cardiovascular outcome has been largely unknown. This study attempted to evaluate whether initial glycemic variability increases cardiovascular events and mortality in diabetic patients with acute ischemic stroke.

Methods: We recruited consecutive patients with acute ischemic stroke or transient ischemic attack from March 2005 to December 2014. Read More

Br J Surg 2017 Jan 30;104(2):e95-e105. Epub 2016 Nov 30.

Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.

Background: There is a clear association between hyperglycaemia and surgical-site infection (SSI). Intensive glucose control may involve a risk of hypoglycaemia, which in turn results in potentially severe complications. A systematic review was undertaken of studies comparing intensive versus conventional glucose control protocols in relation to reduction of SSI and other outcomes, including hypoglycaemia, mortality and stroke. Read More

J Endocrinol Invest 2017 May 21;40(5):457-462. Epub 2016 Nov 21.

1st Propedeutic Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece.

Introduction: Close monitoring of blood glucose levels during the immediate post-acute stroke phase is of great clinical value, as there is evidence that the risk of neurological deterioration is associated with both hyper- and hypoglycaemia. The aim of this review paper is to summarise the evidence on post-stroke blood glucose management and its impact on clinical outcomes, during the early post-acute stage.

Findings: Post-stroke hyperglycaemia has been associated with increased cerebral oedema, haemorrhagic transformation, lower likelihood of recanalisation and deteriorating neurological state. Read More

Endocrine 2017 Sep 9;57(3):464-473. Epub 2016 Nov 9.

Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Policlinico "Mater Domini", Campus Universitario, Viale Europa, 88100,, Catanzaro, Italy.

Purpose: To compare the effect of liraglutide, sitagliptin and insulin glargine added to standard therapy on left ventricular function in post-ischemic type-2 diabetes mellitus patients.

Methods: We evaluated 32 type-2 diabetes mellitus Caucasians with history of post-ischemic chronic heart failure NYHA class II/III and/or left ventricular ejection fraction ≤45 %. Participants underwent laboratory determinations, electrocardiogram, echocardiogram, Minnesota Living with Heart Failure questionnaire and 6 min walking test at baseline and following 52 weeks treatment. Read More

J Cereb Blood Flow Metab 2017 Jul 1;37(7):2577-2583. Epub 2016 Jan 1.

2 Division of Neurocritical Care and Emergency Neurology, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.

Hyperglycemia is a common complication after ischemic stroke, but its link to worse outcome is not well understood. We hypothesized that hyperglycemia may reflect an impaired metabolic response that is associated with worse cytotoxic brain injury. We performed retrospective analysis of magnetic resonance imaging from a cohort of acute ischemic stroke patients prospectively collected from 2006 to 2010 with baseline demographic and laboratory data as well as three-month outcomes. Read More

Am J Emerg Med 2016 Dec 27;34(12):2343-2350. Epub 2016 Aug 27.

National Cancer Control Institute, National Cancer Center, Goyang-si, Kyunggi-do, Republic of Korea.

Background: Hyperglycemia and hyperosmolality are associated with poor outcomes among acute ischemic stroke (AIS) patients.

Objectives: We evaluated the association between hyperglycemia and hyperosmolality, as a combination measure, with poor outcome among AIS patients.

Methods: We conducted a retrospective study of AIS patients admitted to the study hospital emergency department between January and December 2014. Read More

Ann Thorac Surg 2017 Feb 25;103(2):526-532. Epub 2016 Aug 25.

Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address:

Background: Hypoglycemia is a known risk of intensive postoperative glucose control in patients undergoing cardiac operations. However, neither the consequences of hypoglycemia relative to hyperglycemia, nor the possible interaction effects, have been well described. We examined the effects of postoperative hypoglycemia, hyperglycemia, and their interaction on short-term morbidity and mortality. Read More

Clin Transplant 2016 10 24;30(10):1242-1249. Epub 2016 Sep 24.

Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, CA, USA.

Recipient diabetes accounts for ~34% of end-stage renal disease in patients awaiting renal transplantation and has been linked to poor graft function. We conducted a single-center, open-label, randomized controlled trial to determine whether moderately intense glucose control during allograft reperfusion would reduce the incidence of poor graft function. Adult diabetics undergoing deceased donor renal transplant were randomized to moderately intense glucose control (n=30) or standard control (n=30). Read More

Parkinsonism Relat Disord 2016 09 21;30:29-35. Epub 2016 Jun 21.

Department of Neurology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea. Electronic address:

Background: The putamen is frequently involved in cases of secondary choreoballism (CB). To date, no study has investigated clinical features of secondary CB such as vascular CB (vCB) and glycemic CB (gCB) in view of putaminal involvement.

Objectives: Cases of CB with putaminal lesions from our hospital were identified in hospital records. Read More

Tohoku J Exp Med 2016 06;239(2):89-94

Department of Diabetes and Endocrinology, Osaka Red Cross Hospital.

Mitochondrial diabetes mellitus is a subtype of diabetes linked to mutations in mitochondrial DNA. In patients with mitochondrial diabetes mellitus, the effect of glycemic control on the serum concentrations of fibroblast growth factor 21 (FGF21) and growth differentiation factor 15 (GDF15) has not been evaluated. FGF21 and GDF15 have been reported to be useful biomarkers for the diagnosis and severity assessment of mitochondrial diseases like mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). Read More

BMJ Open 2016 Feb 24;6(2):e008203. Epub 2016 Feb 24.

Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia University of Sydney, Northern Clinical School, Sydney, New South Wales, Australia.

Introduction: Both hyperglycaemia and hypoglycaemia in acute ischaemic stroke (AIS) are associated with increased infarct size and worse functional outcomes. Thus, therapies that can maintain normoglycaemia during stroke are clinically important. Glucagon-like peptide 1 (GLP-1) analogues, including exenatide, are routinely used in the treatment of hyperglycaemia in type 2 diabetes, but data on the usefulness of this class of agents in the management of elevated glucose levels in AIS are limited. Read More

Diabetes Obes Metab 2016 Feb 23;18(2):152-8. Epub 2015 Dec 23.

Institute of Cellular Medicine-Diabetes, Newcastle University, Newcastle upon Tyne, UK.

Aims: To examine the relationships between glycated haemoglobin (HbA1c) and cardiovascular (CV) events in people beginning insulin in routine clinical practice in Europe, North America and Asia in a non-interventional study, the Cardiovascular Risk Evaluation in people with Type 2 Diabetes on Insulin Therapy (CREDIT) study.

Methods: Data on 2999 people were collected prospectively over 4 years from physician reports. The primary outcome was the composite of stroke or myocardial infarction (MI) or CV-specific death. Read More

Drugs Today (Barc) 2015 Sep;51(9):519-35

Scripps Clinic and Scripps Whittier Diabetes Institute, La Jolla, California, USA.

Empagliflozin is an oral sodium-glucose cotransporter 2 (SGLT2) inhibitor that reduces hyperglycemia in type 2 diabetes mellitus (T2DM) by decreasing renal glucose reabsorption and promoting urinary glucose excretion. In clinical trials, empagliflozin demonstrated significant improvements in glycemic control, as monotherapy and in combination regimens. In addition, empagliflozin was associated with weight loss and moderate reductions in blood pressure. Read More

Can J Diabetes 2016 Feb 21;40(1):50-7. Epub 2015 Oct 21.

Boehringer Ingelheim Norway KS, Asker, Norway.

Objective: With the expanding armamentarium of noninsulin therapies for type 2 diabetes mellitus, the use of insulin with various oral agents is becoming more common. In this study, we assessed the efficacy and cardiovascular (CV) safety of the dipeptidyl peptidase-4 inhibitor linagliptin as add-on to insulin in patients with type 2 diabetes.

Methods: In this post hoc analysis, data for patients receiving basal or basal-bolus insulin were pooled from 4 randomized, double-blind, phase 3 clinical trials of linagliptin 5 mg once daily or placebo given as add-on to background glucose-lowering treatment. Read More

Zh Nevrol Psikhiatr Im S S Korsakova 2015 ;115(8):79-82

Endocrinology Researh Center, Moscow; Sechenov First Moscow State Medical University, Moscow.

A review of the Russian and international publications on the frequency, risk factors and characteristics of ischemic stroke in patients with type 2 diabetes mellitus (DM-2) is presented. We present a detailed description of specific risk factors for DM-2 (chronic and acute hyperglycemia, recurrent hypoglycemia, insulin resistance and hyperinsulinemia). Current demands to targeted glucose control in patients who survived vascular events are presented. Read More

Congenit Heart Dis 2015 Nov-Dec;10(6):E250-7. Epub 2015 Jul 29.

Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.

Objective: The objective of this study was to characterize the natural history of metabolic uncoupling (type B hyperlactemia and hyperglycemia) following cardiopulmonary bypass (CPB), and to determine the impact of insulin therapy on time to lactate normalization in patients without low cardiac output.

Design: The design used was a retrospective cohort study.

Setting: The study was set in a pediatric cardiac intensive care unit in a tertiary-care urban children's hospital. Read More

J Emerg Med 2015 Aug 20;49(2):244-52. Epub 2015 Mar 20.

Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.

Background: Intravenous tissue-plasminogen activator remains the only U.S. Food and Drug Administration-approved treatment for acute ischemic stroke. Read More

Expert Opin Drug Saf 2015 Apr 29;14(4):505-24. Epub 2015 Jan 29.

University of Liège, CHU Sart Tilman, Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine , (B35), B-4000 Liege 1 , Belgium +32 4 3667238 ; +32 4 3667068 ; andre.scheen @ chu.ulg.ac.be.

Introduction: Dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins) occupy a growing place in the armamentarium of drugs used for the management of hyperglycemia in type 2 diabetes, although some safety concerns have been raised in recent years.

Areas Covered: An updated review providing an analysis of available safety data (meta-analyses, randomized controlled trials, observational cohort and case-control studies and pharmacovigilance reports) with five commercialized DPP-4 inhibitors (sitagliptin, vildagliptin, saxagliptin, alogliptin, linagliptin). A special focus is given to overall safety profile; pancreatic adverse events (AEs) (acute pancreatitis, pancreatic cancer); overall cardiovascular safety (myocardial infarction and stroke); congestive heart failure concern and finally, safety in special populations (elderly, renal impairment). Read More

Neuroscience 2014 Dec 9;283:202-9. Epub 2014 May 9.

Division of Psychoneurobiology, Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany.

Hyperglycemia is a common phenomenon in the early phase of brain injury (BI). The management of blood glucose levels after BI, however, is subject of a growing debate. The occurrence of elevated blood glucose concentrations is linked to increased mortality and worse neurologic outcomes indicating the necessity for therapeutic glucose-lowering. Read More

Stroke 2014 Jun 17;45(6):1881-6. Epub 2014 Apr 17.

From the Department of Neurology, University of California at San Francisco (N.M.R., R.A.S.); and Neurology Service, San Francisco Veterans Affairs Medical Center, CA (R.A.S.).

Endocrine 2014 Nov 7;47(2):360-71. Epub 2014 Mar 7.

Department of Medicine IV, Eberhard-Karls-University, Otfried-Müller-Str. 10, 72076, Tübingen, Germany,

Glucagon-like peptide-1 (GLP-1) stimulates insulin secretion and inhibits glucagon secretion in the pancreatic islets of Langerhans under hyperglycaemia. In type 2 diabetes (T2DM), GLP-1 improves glycaemic control without a hypoglycaemia risk. GLP-1 receptors have also been found in extra-pancreatic tissues, e. Read More

Medicina (B Aires) 2014 ;74(1):37-41

Departamento de Medicina Interna, Instituto de Investigaciones Neurológicas Dr. Raúl Carrea, FLENI, Buenos Aires, Argentina.

Hyperglycemia following an ischemic stroke has been associated with poor clinical outcome. We retrospectively assessed the effect of moderately controlled plasma glucose (correction from 135mg/dl) compared to conservative treatment (correction from 200 mg/dl), as regards neurological evolution, duration of hospitalization, at discharge and at 30 days post-discharge, also complications associated with the treatment in patients admitted to the intensive care unit. We studied 208 patients, 103 (24% diabetics) with moderate therapy and 105 (23% diabetics) with conservative treatment. Read More

Cochrane Database Syst Rev 2014 Feb 14(2):CD009122. Epub 2014 Feb 14.

Institute for General Practice, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Hesse, Germany, 60590.

Background: Clinical guidelines differ regarding their recommended blood glucose targets for patients with type 1 diabetes and recent studies on patients with type 2 diabetes suggest that aiming at very low targets can increase the risk of mortality.

Objectives: To assess the effects of intensive versus conventional glycaemic targets in patients with type 1 diabetes in terms of long-term complications and determine whether very low, near normoglycaemic values are of additional benefit.

Search Methods: A systematic literature search was performed in the databases The Cochrane Library, MEDLINE and EMBASE. Read More

Cochrane Database Syst Rev 2014 Jan 23(1):CD005346. Epub 2014 Jan 23.

Department of Emergency Medicine, Mayo Clinic, Generose Building-G410, 200 First Street SW, Rochester, Minnesota, USA, 55905.

Background: People with hyperglycaemia concomitant with an acute stroke have greater mortality, stroke severity, and functional impairment when compared with those with normoglycaemia at stroke presentation. This is an update of a Cochrane Review first published in 2011.

Objectives: To determine whether intensively monitoring insulin therapy aimed at maintaining serum glucose within a specific normal range (4 to 7. Read More

Nurs Stand 2014 Jan 8-14;28(19):52-6

University of Ulster, Londonderry, Northern Ireland.

Diabetes mellitus is a major risk factor for stroke. Concerns have been raised that adults with acute stroke, irrespective of whether or not they have a history of diabetes mellitus, are at increased risk of experiencing hyperglycaemia and hypoglycaemia. Hyperglycaemia is associated with severe stroke and poor clinical outcomes, therefore blood glucose monitoring and management are essential skills for healthcare professionals caring for patients who have had a stroke. Read More

Am J Clin Dermatol 2014 Feb;15(1):45-50

David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, USA.

Psoriasis patients are at increased risk for cardiovascular disease. Literature on rheumatoid arthritis has shown the association of treatment with tumor necrosis factor (TNF) inhibitors and improvement of cardiovascular disease. Recent literature has also shown similar findings in psoriasis patients. Read More

Curr Diab Rep 2014 Jan;14(1):444

Dubbo Specialist Medical Centre, Dubbo Base Hospital, Suite 1/77, Myall St, Dubbo, NSW, 2830, Australia.

Hyperglycemia is associated with increased mortality and other complications amongst hospitalized patients. However, the studies of tight glycemic control in a range of critical illness settings, including intensive care, acute myocardial infarction, and stroke, have produced inconsistent and divergent results. We examine some of the factors that may have contributed to the differing results, and their implications for targeting tight glucose control in critical illness. Read More

Cochrane Database Syst Rev 2013 Nov 11(11):CD008143. Epub 2013 Nov 11.

Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark, DK-2100.

Background: Patients with type 2 diabetes mellitus (T2D) have an increased risk of cardiovascular disease and mortality compared to the background population. Observational studies report an association between reduced blood glucose and reduced risk of both micro- and macrovascular complications in patients with T2D. Our previous systematic review of intensive glycaemic control versus conventional glycaemic control was based on 20 randomised clinical trials that randomised 29 ,986 participants with T2D. Read More

Clin EEG Neurosci 2014 Apr 4;45(2):126-8. Epub 2013 Sep 4.

Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

Diagnosis of aphasic status epilepticus is sometimes not easy because of its rarity and electroclinical dissociation. Although most cases are associated with organic brain lesions, nonketotic hyperglycemia (NKH)-related aphasic status epilepticus is rare, especially if it is isolated (without other clinical seizure activity). On the other hand, unlike other metabolic disorders, or hypoglycemia-related generalized seizures, focal motor seizure and epilepsia partialis continua can occur in 25% of NKH, with seizures being the initial manifestation in up to 50% of patients. Read More

PLoS One 2013 12;8(6):e66176. Epub 2013 Jun 12.

Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania, United States of America.

Uncontrolled blood glucose in people with diabetes correlates with endothelial cell dysfunction, which contributes to accelerated atherosclerosis and subsequent myocardial infarction, stroke, and peripheral vascular disease. In vitro, both low and high glucose induce endothelial cell dysfunction; however the effect of altered glucose on endothelial cell fluid flow response has not been studied. This is critical to understanding diabetic cardiovascular disease, since endothelial cell cytoskeletal alignment and nitric oxide release in response to shear stress from flowing blood are atheroprotective. Read More

AJNR Am J Neuroradiol 2014 May 2;35(5):833-40. Epub 2013 May 2.

Penn State College of Medicine (A.A.), Milton S. Hershey Medical Center, Hershey, Pennsylvania.

Summary: Smooth neuronal functioning requires an uninterrupted supply of energy that is provided by glucose under normal physiologic conditions. Significant variations in plasma glucose levels, be it hypoglycemia or hyperglycemia, can present with myriad clinical manifestations and may mimic stroke. At times, the diagnosis is either not apparent or not clinically suspected. Read More

Int J Stroke 2014 Feb 19;9(2):246-51. Epub 2013 Mar 19.

Department of Neurology, Medical College of Georgia, Augusta, GA, USA.

Rationale: Patients with acute ischemic stroke and hyperglycemia have worse outcomes than those without hyperglycemia. Intensive glucose control during acute stroke is feasible and can be accomplished safely but has not been fully assessed for efficacy.

Aims: The Stroke Hyperglycemia Insulin Network Effort trial aims to determine the safety and efficacy of standard vs. Read More

Crit Care 2012 Oct 22;16(5):R203. Epub 2012 Oct 22.

Introduction: Hyper- and hypoglycemia are strongly associated with adverse outcomes in critical care. Neurologically injured patients are a unique subgroup, where optimal glycemic targets may differ, such that the findings of clinical trials involving heterogeneous critically ill patients may not apply.

Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing intensive insulin therapy with conventional glycemic control among patients with traumatic brain injury, ischemic or hemorrhagic stroke, anoxic encephalopathy, central nervous system infections or spinal cord injury. Read More

Am J Kidney Dis 2012 Nov 19;60(5):747-69. Epub 2012 Sep 19.

Minneapolis Veterans Affairs Healthcare System, Department of Medicine, University of Minnesota, Minneapolis, MN 55417, USA.

Background: In 2007, the National Kidney Foundation (NKF) published clinical practice guidelines and recommendations for treating patients with diabetes and kidney diseases. Given recent studies that may enhance our understanding of the benefits and harms of glycemic, lipid, and albuminuria management in patients with diabetes and chronic kidney disease (CKD), the NKF commissioned a systematic review to evaluate data on the management of these patients.

Study Design: Systematic review and evidence synthesis. Read More

BMC Neurosci 2012 Aug 6;13:94. Epub 2012 Aug 6.

Department of Cell and Neurobiology, USC Keck School of Medicine, 1333 San Pablo Street, BMT 403, Los Angeles, CA 90089-9112, USA.

Background: Epilepsy is the most common neurological disorder after stroke, affecting more than 50 million persons worldwide. Metabolic disturbances are often associated with epileptic seizures, but the pathogenesis of this relationship is poorly understood. It is known that seizures result in altered glucose metabolism, the reduction of intracellular energy metabolites such as ATP, ADP and phosphocreatine and the accumulation of metabolic intermediates, such as lactate and adenosine. Read More

N Engl J Med 2012 Jul 11;367(4):319-28. Epub 2012 Jun 11.

Background: The provision of sufficient basal insulin to normalize fasting plasma glucose levels may reduce cardiovascular events, but such a possibility has not been formally tested.

Methods: We randomly assigned 12,537 people (mean age, 63.5 years) with cardiovascular risk factors plus impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes to receive insulin glargine (with a target fasting blood glucose level of ≤95 mg per deciliter [5. Read More

Diabetes Technol Ther 2012 Jun;14 Suppl 1:S51-8

Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Center, Aurora, Colorado 80045, USA.

Cardiovascular disease (CVD) remains the leading cause of death in people with diabetes, and the risk of CVD for adults with diabetes is at least two to four times the risk in adults without diabetes. Complications of diabetes, including not only CVD but also microvascular diseases such as retinopathy and nephropathy, are a major health and financial burden. Diabetes is a disease of glucose intolerance, and so much of the research on complications has focused on the role of hyperglycemia. Read More

J Cardiovasc Nurs 2013 Mar-Apr;28(2):157-65

Mid-America Diabetes Associates, Wichita, Kansas 67226, USA.

Background: Diabetes is a complex and chronic metabolic disease characterized by hyperglycemia due to defects in the secretion and action of insulin. Diabetes affects more than 8% of the US population. Type 2 diabetes mellitus (T2DM) is the most common form of diabetes and is associated with the development of a number of devastating microvascular complications, including retinopathy, neuropathy, and nephropathy. Read More

Lancet Neurol 2012 Mar;11(3):261-71

Department of Neurology, University Medical Centre Utrecht Stroke Centre and Rudolf Magnus Institute of Neuroscience, UMC Utrecht, Utrecht, Netherlands.

Diabetes and ischaemic stroke often arise together. People with diabetes have more than double the risk of ischaemic stroke after correction for other risk factors, relative to individuals without diabetes. Multifactorial treatment of risk factors for stroke-in particular, lifestyle factors, hypertension, and dyslipidaemia-will prevent a substantial number of these disabling strokes. Read More