Hostname: page-component-848d4c4894-hfldf Total loading time: 0 Render date: 2024-06-01T18:06:33.363Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of Glucose Fluctuation on Acute Cerebral Infarction in Type 2 Diabetes

Published online by Cambridge University Press:  20 October 2014

Jinxin Huang ,
Xingguang Zhang ,
Juan Li ,
Liya Tang ,
Xiumin Jiao  and
Xiaofeng Lv
Jinxin Huang
Affiliation:
Beijing Military General Hospital, No. 5 Nan Men Cang, Dongcheng district, Beijing, China
Xingguang Zhang
Affiliation:
Beijing Military General Hospital, No. 5 Nan Men Cang, Dongcheng district, Beijing, China
Juan Li
Affiliation:
Beijing Military General Hospital, No. 5 Nan Men Cang, Dongcheng district, Beijing, China
Liya Tang
Affiliation:
Beijing Military General Hospital, No. 5 Nan Men Cang, Dongcheng district, Beijing, China
Xiumin Jiao
Affiliation:
Beijing Military General Hospital, No. 5 Nan Men Cang, Dongcheng district, Beijing, China
Xiaofeng Lv*
Affiliation:
Beijing Military General Hospital, No. 5 Nan Men Cang, Dongcheng district, Beijing, China
*
Beijing Military General Hospital, No. 5 Nan Men Cang, Dongcheng district, Beijing 100700, China. Email: xiaofenglv7966@163.com.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

This study aimed to describe the frequency and temporal profile of acute cerebral infarction (ACI) using a continuous glucose monitoring system (CGMS) in patients with and without type 2 diabetes mellitus (T2DM) and explore the impact of blood glucose fluctuations on the short-term prognosis of ACI.

Methods:

The subjects were divided into four groups: T2DM with acute cerebral infarction (DMCI, Group A, n=56); T2DM without acute cerebral infarction (DM-NCI, Group B, n=36); Acute cerebral infarction patients without T2DM (NDM-CI, Group C, n=54); Healthy control group (NG, Group D, n=36). The National Institutes of Health Stoke Scale (NIHSS) and modified Rankin scale (mRs) were collected in Group A and C. All subjects were monitored for 72 hours using the CGMS. Indices such as fasting blood glucose (FBG) and mean amplitude of glycemic excursions (MAGE) were calculated. Glycemic excursions were compared between Group A, B, C and Group D, respectively. Multiple linear regression analysis and logistic analysis was applied.

Results:

MAGE is related to NIHSS, homocysteine (HCY), HOMA-IR, FBG, CRP and IMT, while NIHSS is related to CRP, HCY, HOMA-IR, IMT. The factors impacting the short-term prognosis of ACI were NIHSS, HBA1C and MAGE.

Conclusion:

Larger glucose fluctuations are associated with more stroke risk factors and are associated with a poorer short-term prognosis. More attention should be paid to glucose fluctuations in patients with ACI and a history of T2DM.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 4 , July 2014 , pp. 486 - 492
Copyright
Copyright © The Canadian Journal of Neurological 2014

References

1.Yang, ZJ, Liu, J, Ge, JP, Chen, L, Zhao, ZG, Yang, WY.Prevalence of cardiovascular disease risk factor in the Chinese population: the 2007–2008 China National Diabetes and Metabolic Disorders Study. Eur Heart J. 2012;33(2):213–20.CrossRefGoogle ScholarPubMed
2.Barrett-Connor, E, Khaw, KT.Diabetes mellitus: an independent risk factor for stroke? Am J Epidemiol. 1988;128(1):116–23.CrossRefGoogle ScholarPubMed
3.Burchfiel, CM, Curb, JD, Rodriguez, BL, Abbott, RD, Chiu, D, Yano, K.Glucose intolerance and 22-year stroke incidence. The Honolulu Heart Program. Stroke. 1994;25(5):951–7.CrossRefGoogle ScholarPubMed
4.Folsom, AR, Rasmussen, ML, Chambless, LE, et al. Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Diabetes Care. 1999;22(7):1077–83.Google ScholarPubMed
5.Capes, SE, Hunt, D, Malmberg, K, Pathak, P, Gerstein, HC.Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001;32(10):2426–32.CrossRefGoogle ScholarPubMed
6.Baird, TA, Parsons, MW, Phanh, T, et al. Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke. 2003;34(9):2208–14.CrossRefGoogle ScholarPubMed
7.Parsons, MW, Barber, PA, Desmond, PM, et al. Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol. 2002;52(1):20–8.CrossRefGoogle ScholarPubMed
8.Sykora, M, Diedler, J, Turcani, P, Hacke, W, Steiner, T.Baroreflex: a new therapeutic target in human stroke? Stroke. 2009;40(12):e678–82.CrossRefGoogle ScholarPubMed
9.Ay, H, Arsava, EM, Koroshetz, WJ, Sorensen, AG.Middle cerebral artery infarcts encompassing the insula are more prone to growth. Stroke. 2008;39(2):373–8.CrossRefGoogle ScholarPubMed
10.Lachin, JM, Genuth, S, Nathan, DM, Zinman, B, Rutledge, BN.Effect of glycemic exposure on the risk of microvascular complications in the diabetes control and complications trial–revisited. Diabetes. 2008;57(4):995–1001.CrossRefGoogle ScholarPubMed
11.Meigs, JB, Nathan, DM, D'Agostino, RB Sr., Wilson, PW, Framingham Offspring Study. Fasting and postchallenge glycemia and cardiovascular disease risk: the Framingham Offspring Study. Diabetes Care. 2002;25(10):1845–50.CrossRefGoogle ScholarPubMed
12.Ceriello, A, Hanefeld, M, Leiter, L, et al. Postprandial glucose regulation and diabetic complications. Arch Intern Med. 2004;164(19):2090–5.CrossRefGoogle ScholarPubMed
13.Gerich, JE.Clinical significance, pathogenesis, and management of postprandial hyperglycemia. Arch Intern Med. 2003;163(11):1306–16.CrossRefGoogle ScholarPubMed
14.Quagliaro, L, Piconi, L, Assaloni, R, Martinelli, L, Motz, E, Ceriello, A.Intermittent high glucose enhances apoptosis related to oxidative stress in human umbilical vein endothelial cells: the role of protein kinase C and NAD(P)H-oxidase activation. Diabetes. 2003;52(11):2795–804.CrossRefGoogle ScholarPubMed
15.Brott, T, Adams, HP Jr., Olinger, CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864–70.CrossRefGoogle ScholarPubMed
16.Bonita, R, Beaglehole, R.Recovery of motor function after stroke. Stroke. 1988;19(12):1497–500.CrossRefGoogle ScholarPubMed
17.The Chinese Medical Association TCion. Diagnosis of cerebrovascular disease. J Neurology. 1996;29(6):379.Google Scholar
18.Colman, PG, Thomas, DW, Zimmet, PZ, Welborn, TA, Garcia-Webb, P, Moore, MP.New classification and criteria for diagnosis of diabetes mellitus. The Australasian Working Party on Diagnostic Criteria for Diabetes Mellitus. N Z Med J. 1999;112(1086):139–41.Google Scholar
19.Gray, CS, Hildreth, AJ, Sandercock, PA, et al. Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia: the UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurol. 2007;6(5):397–406.CrossRefGoogle ScholarPubMed
20.Martini, SR, Kent, TA.Hyperglycemia in acute ischemic stroke: a vascular perspective. J Cereb Blood Flow Metab. 2007;27(3):435–51.CrossRefGoogle ScholarPubMed
21.Naber, CK, Mehta, RH, Junger, C, et al. Impact of admission blood glucose on outcomes of nondiabetic patients with acute ST-elevation myocardial infarction (from the German Acute Coronary Syndromes [ACOS] Registry). Am J Cardiol. 2009;103(5):583–7.Google Scholar
22.Williams, LS, Rotich, J, Qi, R, et al. Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke. Neurology. 2002;59(1):67–71.CrossRefGoogle ScholarPubMed
23.D'Olhaberriague, L, Litvan, I, Mitsias, P, Mansbach, HH.A reappraisal of reliability and validity studies in stroke. Stroke. 1996;27(12):2331–6.CrossRefGoogle ScholarPubMed
24.Suwa, T, Ohta, A, Matsui, T, et al. Relationship between clinical markers of glycemia and glucose excursion evaluated by continuous glucose monitoring (CGM). Endocr J. 2010;57(2):135–40.CrossRefGoogle ScholarPubMed
25.Krinsley, JS.Glycemic variability: a strong independent predictor of mortality in critically ill patients. Crit Care Med. 2008;36(11):3008–13.CrossRefGoogle Scholar
26.Holmes, MV, Newcombe, P, Hubacek, JA, et al. Effect modification by population dietary folate on the association between MTHFR genotype, homocysteine, and stroke risk: a meta-analysis of genetic studies and randomised trials. Lancet. 2011;378(9791):584–94.CrossRefGoogle Scholar
27.Phipps, MS, Jastreboff, AM, Furie, K, Kernan, WN.The diagnosis and management of cerebrovascular disease in diabetes. Curr Diab Rep. 2012;12(3):314–23.CrossRefGoogle ScholarPubMed
28.Martin, RJ, Ratan, RR, Reding, MJ, Olsen, TS.Higher blood glucose within the normal range associated with more severe strokes. Stroke Res Treat. 2012;2012:659-610.Google ScholarPubMed
29.Azuma, K, Kawamori, R, Toyofuku, Y, et al. Repetitive fluctuations in blood glucose enhance monocyte adhesion to the endothelium of rat thoracic aorta. Arterioscler Thromb Vasc Biol. 2006;26(10):2275–80.CrossRefGoogle Scholar
30.Russo, VC, Higgins, S, Werther, GA, Cameron, FJ.Effects of fluctuating glucose levels on neuronal cells in vitro. Neurochem Res. 2012;37(8):1768–82.CrossRefGoogle ScholarPubMed
31.Kim, M, Chung, H, Yoon, C, et al. Increase of INS-1 cell apoptosis under glucose fluctuation and the involvement of FOXO-SIRT pathway. Diabetes Res Clin Pract. 2012;98(1):132–9.CrossRefGoogle ScholarPubMed