Impact of glycemic treatment and blood glucose monitoring on outcomes in patients with acute ischemic stroke without prior diabetes: a longitudinal cohort study

Hsi-Hsing Yang; Wu-Chien Chien; Jen-Jiuan Liaw; Chia-Chen Yang; Chi-Hsiang Chung; Shi-Hao Huang; Yao-Ching Huang; Bing-Long Wang; Ren-Jei Chung; Peng-Ciao Chen; Ting-Ti Lin; Pi-Ching Yu; Yu-Ju Chen

doi:10.1186/s13098-024-01542-2

Impact of glycemic treatment and blood glucose monitoring on outcomes in patients with acute ischemic stroke without prior diabetes: a longitudinal cohort study

Diabetol Metab Syndr. 2024 Dec 19;16(1):302. doi: 10.1186/s13098-024-01542-2.

Authors

Hsi-Hsing Yang^{1

2}, Wu-Chien Chien^#^{3

4}, Jen-Jiuan Liaw⁵, Chia-Chen Yang⁵, Chi-Hsiang Chung^{6

7}, Shi-Hao Huang^{6

7

8}, Yao-Ching Huang^{6

7

8}, Bing-Long Wang⁷, Ren-Jei Chung⁸, Peng-Ciao Chen⁵, Ting-Ti Lin⁵, Pi-Ching Yu^{9

10}, Yu-Ju Chen^#¹¹

Affiliations

¹ Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, 71004, Taiwan.
² Department of Biotechnology and Food Technology, Southern Taiwan University of Science and Technology, Tainan, 71005, Taiwan.
³ Department of Medical Research, Tri-Service General Hospital, Taipei, 11490, Taiwan. chienwu@mail.ndmctsgh.edu.tw.
⁴ School of Public Health, National Defense Medical Center, Taipei, 11490, Taiwan. chienwu@mail.ndmctsgh.edu.tw.
⁵ School of Nursing, National Defense Medical Center, Taipei, 11490, Taiwan.
⁶ Department of Medical Research, Tri-Service General Hospital, Taipei, 11490, Taiwan.
⁷ School of Public Health, National Defense Medical Center, Taipei, 11490, Taiwan.
⁸ Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei, 10608, Taiwan.
⁹ Graduate Institute of Medicine, National Defense Medical Center, Taipei, 11490, Taiwan.
¹⁰ Cardiovascular Intensive Care Unit, Department of Critical Care Medicine, Far-Eastern Memorial Hospital, New Taipei City, 10602, Taiwan.
¹¹ School of Nursing, National Defense Medical Center, Taipei, 11490, Taiwan. judychen37@gmail.com.

^# Contributed equally.

Abstract

Objectives: To explore the short- and long-term effects of glycemic management-through glycemic treatment and blood glucose monitoring (BGM)-on stroke recurrence and mortality specifically in patients experiencing a first-ever ischemic stroke (FIS) with hyperglycemia (FISHG) who have not previously been diagnosed with diabetes mellitus (DM).

Methods: We gathered data on patients who were registered on Taiwan's National Health Insurance Research Database from 2000 to 2015. We one-fold propensity-score-matched (by sex, age, and index date) 207,054 patients into 3 cohorts: those with FIS (1) without hyperglycemia, (2) hyperglycemia without glycemic treatment, and (3) hyperglycemia with glycemic treatment. We used Cox proportional hazard regression to evaluate the short- (within 1 year after FIS) and long-term (9.3 ± 8.6 years after FIS) prognostic effects of glycemic management on stroke recurrence and mortality of FISHG.

Results: Stroke recurrence and mortality were significantly more likely in the patients with FISHG than their counterparts without hyperglycemia (p < 0.05). Under glycemic treatment, patients with FISHG demonstrated lower risk of mortality at every follow-up than those without (p < 0.001) but were not less likely to have stroke recurrence (p > 0.05). Integrating BGM with glycemic treatment in the FISHG cohort significantly reduced the risk of stroke recurrence compared to patients receiving only glycemic treatment at 1-month, 3-month, 6-month, and 1-year post-stroke follow-ups (adjusted hazard ratios = 0.84, 0.90, 0.88, and 0.92, respectively); additionally, this approach significantly decreased mortality risk at each post-stroke follow-up period (p < 0.05).

Conclusions: BGM combined with glycemic treatment significantly improves prognosis in patients with FISHG who have not been previously diagnosed with DM, reducing the risks of stroke recurrence and mortality.

Keywords: Blood glucose monitoring; First-ever ischemic stroke; Glycemic treatment; Hyperglycemia; Mortality; Stroke recurrence.