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Syst Rev 2022 06 2;11(1):110. Epub 2022 Jun 2.

School of Management, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.

Background: Continuous glucose monitors (CGMs) can measure interstitial fluid glucose levels to provide comprehensive real-time glucose profile among people with type 2 diabetes. These can accurately detect glucose levels, hyperglycaemia and hypoglycaemia events compared with conventional self-monitoring. Increased application of CGMs provides a valuable opportunity to evaluate glucose control on oral anti-diabetic medications. Read More

J Clin Med 2022 Mar 11;11(6). Epub 2022 Mar 11.

Endocrinology-Metabolic Diseases, Hôpital Saint-André, Bordeaux University, 33000 Bordeaux, France.

(1) Background: Hyperglycaemia and hypoglycaemia are both emerging risk factors for cardiovascular disease. Nevertheless, the potential effect of glycaemic variability (GV) on mid-term major cardiovascular events (MACE) in diabetic patients presenting with acute heart failure (AHF) remains unclear. This study investigates the prognostic value of GV in diabetic patients presenting with acute heart failure (AHF). Read More

Diabetes Care 2022 04;45(4):789-797

Baker Heart and Diabetes Institute, Melbourne, Australia.

Objective: To determine trends in the incidence of major diabetes-related complications in Australia.

Research Design And Methods: This study included 70,885 people with type 1 and 1,089,270 people with type 2 diabetes registered on the Australian diabetes registry followed from July 2010 to June 2019. Outcomes (hospitalization for myocardial infarction [MI], stroke, heart failure [HF], lower-extremity amputation [LEA], hypoglycemia, and hyperglycemia) were obtained via linkage to hospital admissions databases. Read More

Curr Opin Nephrol Hypertens 2022 01;31(1):72-81

Providence Healthcare, Spokane.

Purpose Of Review: Diabetes mellitus is a leading cause of chronic kidney disease (CKD) that confers faster kidney disease progression, higher mortality, and various metabolic derangements including hypoglycemia.

Recent Findings: Even in the absence of diabetes mellitus, growing research demonstrates that CKD patients are at heightened risk for hypoglycemia via multiple pathways. In CKD patients transitioning to end-stage renal disease (ESRD), spontaneous resolution of hyperglycemia and frequent hypoglycemia resulting in reduction and/or cessation of glucose-lowering medications are frequently observed in a phenomenon described as 'burnt-out diabetes'. Read More

Sci Rep 2021 06 1;11(1):11523. Epub 2021 Jun 1.

Stroke Center and Department of Neurology, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, 10055, Taiwan.

This pilot, randomized, open-label controlled study compared the basal-bolus regimens of insulin glargine (IG) and neutral protamine Hagedorn (NPH) insulin in stroke patients with hyperglycemia receiving intensive care. The study recruited acute stroke patients requiring intensive care within 72 h (h) of onset and had blood glucose > 200 mg/dL. 50 patients received IG (n = 26) or NPH (n = 24) with added short-acting prandial regular insulin over a 72-h period. Read More

Mol Metab 2021 04 14;46:101102. Epub 2020 Oct 14.

Diabetes Division, Katholisches Klinikum Bochum, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.

Background: GLP-1 receptor agonists (GLP-1 RAs) with exenatide b.i.d. Read More

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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