Stroke Patients With High Blood Sugar at Higher R
July 15, 2002, Acurian
Source: Indiana University
INDIANAPOLIS - Stroke patients who have hyperglycemia (high blood
sugar) at the time of admission to the hospital for treatment of the
stroke are at higher risk of death than stroke patients with normal
blood sugar levels, according to a study published in the July 9,
2002, issue of the journal Neurology by researchers from the Indiana
University School of Medicine, the Richard L. Roudebush Veterans
Administration Medical Center and the Regenstrief Institute for
Health Care.
The researchers led by the study’s principal investigator, Linda S.
Williams, M.D., assistant professor of neurology at the IU School of
Medicine, analyzed the electronic medical records of 656 stroke
patients hospitalized over a five-year period. Over 40 percent of
these stroke patents had high blood sugar levels. Although most had
previous diagnoses of diabetes, they did not have their blood sugar
levels under control.
Dr. Williams and her colleagues found that having high blood sugar
when the stroke occurred put patients at risk for higher 30-day, 1-
year and 5-year mortality than if blood sugar levels were in the
normal range. Patients with high blood sugar also stayed longer in
the hospital and had higher hospital costs than those with normal
blood sugar.
The researchers also reported that during hospitalization, the
patients’ hyperglycemia usually was not adequately addressed, with
more than 90% of the hyperglycemic patients continuing to have high
blood sugar during their hospital stay. They noted that although many
treatments are available to lower blood sugar, improvements are
needed in the implementation of these treatments during
hospitalization.
“Diabetes is a growing problem in the United States. With the link
shown in our study between diabetes and poor outcome after stroke,
hyperglycemia at the time of stroke may become an even greater
problem in years ahead both in terms of deaths and medical costs,”
says Dr. Williams.
Data used in the study was obtained from the Regenstrief Medical
Records System, a physician-designed integrated inpatient and
outpatient information system that is the largest coded, continuously
operated electronic medical records system in the country.
“In the past, strokes and their devastating outcomes were considered
almost ‘acts of God,’ a ’stroke’ out of the blue. Now we know that
they can be prevented, and once they occur, their consequences can be
minimized through the use of thrombolytic ‘clot-busting’ drugs. This
new study shows that other metabolic abnormalities such as
hyperglycemia may also have substantial effects on outcomes of
strokes. I hope this important yet preliminary study will lead to a
controlled trial of tight blood glucose control among stroke patients
with diabetes,” notes William Tierney, M.D., senior author of the
study.
The National Institutes of Health recently funded this group of IU
School of Medicine neurologists and endocrinologists to conduct a
phase II study of rapid normalization of high blood sugar at the time
of stroke. “This treatment is potentially very appealing,” says Dr.
Williams, “because it is available at any hospital and is familiar to
all physicians, so it could be widely used without major changes in
the current health care system.”