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Glycemic Control of Stroke Patients and Their Outcomes in a Comprehensive Stroke Center at a Tertiary Care Hospital: A Retrospective Cohort

Received: 17 April 2020     Accepted: 9 May 2020     Published: 28 May 2020
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Abstract

Background: Diabetes mellitus is one of the major modifiable risk factors for having a stroke and those who present with a stroke are found to have hyperglycemia. The association between hyperglycemia and stroke has been found in an increasing number of studies. Evidence indicates that persistent in-hospital hyperglycemia during the first 24 hours after acute ischemic stroke (AIS) is associated with worse outcomes than normoglycemia. We conducted a retrospective chart review to see the glycemic control of stroke patients and their hospital outcome over a 3-month period as part of a pre-evaluation assessment to develop a hyperglycemia protocol in the stroke unit. Methods: Institutional review board approval was obtained for this study. A total of 142 patients with acute stroke admitted in the Comprehensive Stroke Center at Jersey Shore University Medical Center over a 3-month period were included in this study. Demographic characteristics, comorbidities, glycemic patterns at admission and throughout the hospital stay, types of stroke, length of stay, NIH (National Institutes of Health) stroke scale on admission and discharge, discharge disposition and outcome were reviewed retrospectively. Statistical analysis was performed by SPSS and a nova with tukey as post-hoc analysis. For the graph, we used prism and for the regression analysis, stat disk was used. Results: Average age of the patients was 73 years, with male predominance (54%). Average BMI of the patients was 28.2. Most of the patients had an ischemic stroke (73%). Major comorbidities were hypertension (88%), dyslipidemia (66%), and diabetes (36%). About 8 of 143 (6%) patients were newly diagnosed with diabetes. Average Hba1C was 6.5. For a detailed statistical analysis, we divided patients into three groups by their blood glucose levels ranging from 80-140 mg/dl in group 1, 140-180 mg/dl in group 2, and more than 180 mg /dl in group 3. Then, we compared the length of stay (LOS), NIH scale admission/discharge, types of stroke and discharge disposition within the three groups. This study showed that the NIH stroke scale on admission in group 3 (blood glucose >180mg/dl) was higher compared to group 1 (blood glucose 80-140 mg/dl), with a p value of <0.01. Length of stay was more in group 3 compared to group 1 and 2, with a P value < 0.08. Conclusion: Although this study limited by smaller patient groups, but it concludes that higher blood glucose level associated with higher NIH stroke scale at admission and during discharge and have increased length of stay which is consistent with other similar studies

Published in American Journal of Internal Medicine (Volume 8, Issue 3)
DOI 10.11648/j.ajim.20200803.17
Page(s) 133-137
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Diabetes, Stroke, Hyperglycemia, Hypoglycemia

References
[1] Lau, L. H., et al., Prevalence of diabetes and its effects on stroke outcomes: A meta-analysis and literature review. Journal of diabetes investigation, 2019. 10 (3): p. 780-792.
[2] Benjamin, E. J., P. Muntner, and M. S. Bittencourt, Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation, 2019. 139 (10): p. e56-e528.
[3] Chen, R., B. Ovbiagele, and W. Feng, Diabetes and stroke: epidemiology, pathophysiology, pharmaceuticals and outcomes. The American journal of the medical sciences, 2016. 351 (4): p. 380-386.
[4] Gaillard, T. and E. Miller, Guidelines for Stroke Survivors with Diabetes Mellitus. Stroke, 2018. 49 (6): p. e215-e217.
[5] Semenkovich, C. F., We know more than we can tell about diabetes and vascular disease: The 2016 Edwin Bierman Award Lecture. Diabetes, 2017. 66 (7): p. 1735-1741.
[6] Pechlivani, N. and R. A. Ajjan, Thrombosis and vascular inflammation in diabetes: mechanisms and potential therapeutic targets. Frontiers in cardiovascular medicine, 2018. 5: p. 1.
[7] Zhang, X., et al., Prevalence of abnormal glucose regulation according to different diagnostic criteria in ischemic stroke without a history of diabetes. BioMed research international, 2018.
[8] Control, C. f. D. and Prevention, National diabetes statistics report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services, 2017. 20.
[9] Benjamin, E. J., et al., Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation, 2018. 137 (12): p. e67.
[10] Powers, W. J., et al., 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2018. 49 (3): p. e46-e99.
[11] Emanuele, M. and N. Emanuele, Management of Diabetes in Stroke, in Primer on Cerebrovascular Diseases. 2017, Elsevier. p. 756-759.
[12] Bruno, A., et al., Acute blood glucose level and outcome from ischemic stroke. Neurology, 1999. 52 (2): p. 280-280.
[13] Johnston, K. C., et al., Intensive vs standard treatment of hyperglycemia and functional outcome in patients with acute ischemic stroke: the SHINE randomized clinical trial. JAMA, 2019. 322 (4): p. 326-335.
[14] Spss, I., IBM SPSS statistics for Windows, version 20.0. New York: IBM Corp, 2011. 440.
[15] Weir, C. J., et al., Is hyperglycemia an independent predictor of poor outcome after acute stroke? Results of a long term follow up study. BMJ 1997. 314 (7090): p. 1303.
[16] Capes, S. E., et al., Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke, 2001. 32 (10): p. 2426-2432.
[17] Parsons, M. W., et al., Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 2002. 52 (1): p. 20-28.
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  • APA Style

    Mohammad Amir Hossain, Barbara Wyczesany, Dwyer Jackie, Swapnil Patel, Khushboo Agarwal, et al. (2020). Glycemic Control of Stroke Patients and Their Outcomes in a Comprehensive Stroke Center at a Tertiary Care Hospital: A Retrospective Cohort. American Journal of Internal Medicine, 8(3), 133-137. https://doi.org/10.11648/j.ajim.20200803.17

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    ACS Style

    Mohammad Amir Hossain; Barbara Wyczesany; Dwyer Jackie; Swapnil Patel; Khushboo Agarwal, et al. Glycemic Control of Stroke Patients and Their Outcomes in a Comprehensive Stroke Center at a Tertiary Care Hospital: A Retrospective Cohort. Am. J. Intern. Med. 2020, 8(3), 133-137. doi: 10.11648/j.ajim.20200803.17

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    AMA Style

    Mohammad Amir Hossain, Barbara Wyczesany, Dwyer Jackie, Swapnil Patel, Khushboo Agarwal, et al. Glycemic Control of Stroke Patients and Their Outcomes in a Comprehensive Stroke Center at a Tertiary Care Hospital: A Retrospective Cohort. Am J Intern Med. 2020;8(3):133-137. doi: 10.11648/j.ajim.20200803.17

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  • @article{10.11648/j.ajim.20200803.17,
      author = {Mohammad Amir Hossain and Barbara Wyczesany and Dwyer Jackie and Swapnil Patel and Khushboo Agarwal and Rabail Soomro and Brian Yung and Arda Akoluk and Stephen Martino and Jennifer Cheng and Raquel Ong and Arif Asif},
      title = {Glycemic Control of Stroke Patients and Their Outcomes in a Comprehensive Stroke Center at a Tertiary Care Hospital: A Retrospective Cohort},
      journal = {American Journal of Internal Medicine},
      volume = {8},
      number = {3},
      pages = {133-137},
      doi = {10.11648/j.ajim.20200803.17},
      url = {https://doi.org/10.11648/j.ajim.20200803.17},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20200803.17},
      abstract = {Background: Diabetes mellitus is one of the major modifiable risk factors for having a stroke and those who present with a stroke are found to have hyperglycemia. The association between hyperglycemia and stroke has been found in an increasing number of studies. Evidence indicates that persistent in-hospital hyperglycemia during the first 24 hours after acute ischemic stroke (AIS) is associated with worse outcomes than normoglycemia. We conducted a retrospective chart review to see the glycemic control of stroke patients and their hospital outcome over a 3-month period as part of a pre-evaluation assessment to develop a hyperglycemia protocol in the stroke unit. Methods: Institutional review board approval was obtained for this study. A total of 142 patients with acute stroke admitted in the Comprehensive Stroke Center at Jersey Shore University Medical Center over a 3-month period were included in this study. Demographic characteristics, comorbidities, glycemic patterns at admission and throughout the hospital stay, types of stroke, length of stay, NIH (National Institutes of Health) stroke scale on admission and discharge, discharge disposition and outcome were reviewed retrospectively. Statistical analysis was performed by SPSS and a nova with tukey as post-hoc analysis. For the graph, we used prism and for the regression analysis, stat disk was used. Results: Average age of the patients was 73 years, with male predominance (54%). Average BMI of the patients was 28.2. Most of the patients had an ischemic stroke (73%). Major comorbidities were hypertension (88%), dyslipidemia (66%), and diabetes (36%). About 8 of 143 (6%) patients were newly diagnosed with diabetes. Average Hba1C was 6.5. For a detailed statistical analysis, we divided patients into three groups by their blood glucose levels ranging from 80-140 mg/dl in group 1, 140-180 mg/dl in group 2, and more than 180 mg /dl in group 3. Then, we compared the length of stay (LOS), NIH scale admission/discharge, types of stroke and discharge disposition within the three groups. This study showed that the NIH stroke scale on admission in group 3 (blood glucose >180mg/dl) was higher compared to group 1 (blood glucose 80-140 mg/dl), with a p value of <0.01. Length of stay was more in group 3 compared to group 1 and 2, with a P value < 0.08. Conclusion: Although this study limited by smaller patient groups, but it concludes that higher blood glucose level associated with higher NIH stroke scale at admission and during discharge and have increased length of stay which is consistent with other similar studies},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Glycemic Control of Stroke Patients and Their Outcomes in a Comprehensive Stroke Center at a Tertiary Care Hospital: A Retrospective Cohort
    AU  - Mohammad Amir Hossain
    AU  - Barbara Wyczesany
    AU  - Dwyer Jackie
    AU  - Swapnil Patel
    AU  - Khushboo Agarwal
    AU  - Rabail Soomro
    AU  - Brian Yung
    AU  - Arda Akoluk
    AU  - Stephen Martino
    AU  - Jennifer Cheng
    AU  - Raquel Ong
    AU  - Arif Asif
    Y1  - 2020/05/28
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ajim.20200803.17
    DO  - 10.11648/j.ajim.20200803.17
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
    SP  - 133
    EP  - 137
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20200803.17
    AB  - Background: Diabetes mellitus is one of the major modifiable risk factors for having a stroke and those who present with a stroke are found to have hyperglycemia. The association between hyperglycemia and stroke has been found in an increasing number of studies. Evidence indicates that persistent in-hospital hyperglycemia during the first 24 hours after acute ischemic stroke (AIS) is associated with worse outcomes than normoglycemia. We conducted a retrospective chart review to see the glycemic control of stroke patients and their hospital outcome over a 3-month period as part of a pre-evaluation assessment to develop a hyperglycemia protocol in the stroke unit. Methods: Institutional review board approval was obtained for this study. A total of 142 patients with acute stroke admitted in the Comprehensive Stroke Center at Jersey Shore University Medical Center over a 3-month period were included in this study. Demographic characteristics, comorbidities, glycemic patterns at admission and throughout the hospital stay, types of stroke, length of stay, NIH (National Institutes of Health) stroke scale on admission and discharge, discharge disposition and outcome were reviewed retrospectively. Statistical analysis was performed by SPSS and a nova with tukey as post-hoc analysis. For the graph, we used prism and for the regression analysis, stat disk was used. Results: Average age of the patients was 73 years, with male predominance (54%). Average BMI of the patients was 28.2. Most of the patients had an ischemic stroke (73%). Major comorbidities were hypertension (88%), dyslipidemia (66%), and diabetes (36%). About 8 of 143 (6%) patients were newly diagnosed with diabetes. Average Hba1C was 6.5. For a detailed statistical analysis, we divided patients into three groups by their blood glucose levels ranging from 80-140 mg/dl in group 1, 140-180 mg/dl in group 2, and more than 180 mg /dl in group 3. Then, we compared the length of stay (LOS), NIH scale admission/discharge, types of stroke and discharge disposition within the three groups. This study showed that the NIH stroke scale on admission in group 3 (blood glucose >180mg/dl) was higher compared to group 1 (blood glucose 80-140 mg/dl), with a p value of <0.01. Length of stay was more in group 3 compared to group 1 and 2, with a P value < 0.08. Conclusion: Although this study limited by smaller patient groups, but it concludes that higher blood glucose level associated with higher NIH stroke scale at admission and during discharge and have increased length of stay which is consistent with other similar studies
    VL  - 8
    IS  - 3
    ER  - 

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Author Information
  • Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, USA

  • Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, USA

  • Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, USA

  • Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, USA

  • Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, USA

  • Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, USA

  • Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, USA

  • Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, USA

  • Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, USA

  • Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, USA

  • Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, USA

  • Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, USA

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