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The initial glycemic variability is associated with early neurological deterioration in diabetic patients with acute ischemic stroke

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Abstract

The association between glycemic variability and early neurological deterioration (END) in acute ischemic stroke remains unclear. This study attempted to explore whether initial glycemic variability increases END in diabetic patients with acute ischemic stroke. We enrolled type 2 diabetic patients undergoing acute ischemic stroke from November 2015 to November 2016. A total of 336 patients within 72 h from stroke onset were included. The serum glucose levels were checked four times per day during the initial 3 hospital days. The standard deviation of blood glucose (SDBG) values and the mean amplitude of glycemic excursions (MAGE) were calculated for glycemic variability. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) ≥ 2 points between hospital days 0 and 5. The frequencies of END and HbA1c were significantly different in subjects grouped according to tertiles of MAGE (9.09, 12.07 and 50.00%, p < 0.001 for END; 7.36 ± 1.91, 7.83 ± 1.93 and 8.56 ± 1.79, p < 0.001 for HbA1c). Compared to patients without END, patients with END had significantly higher HbA1c levels (8.30 ± 1.92 vs 7.80 ± 1.93, p = 0.043), increased SDBG (3.42 ± 1.14 vs 2.60 ± 0.96, p < 0.001), and increased MAGE (6.46 ± 2.09 vs 4.59 ± 1.91, p < 0.001). In a multivariable logistic regression, stroke etiology (OR 0.675; 95% CI 0.485–0.940, p = 0.020), baseline NIHSS (OR 1.086; 95% CI 1.004–1.175, p = 0.040), and MAGE (OR 1.479; 95% CI 1.162–1.882, p = 0.001) were significantly associated with END. Initial glycemic variability is associated with END in diabetic patients with acute ischemic stroke.

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Funding

This research was supported by National Natural Science Foundation of China (No.81201051, Guangjun Xi; No.81401619, Jiaojie Hui; No.81671219, Zaiwang Li), Natural Science Foundation of Jiangsu Province (No.BK2012097, Guangjun Xi; No.BK20151109, Zaiwang Li) and Medical Young Talents Program of Jiangsu Province (No.QNRC2016191, Guangjun Xi; No.QNRC2016178, Jiaojie Hui).

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Authors and Affiliations

  1. Department of Critical Care Medicine, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, 214023, China

    Jiaojie Hui

  2. Department of Neurology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, 214023, People’s Republic of China

    Jianping Zhang, Xuqiang Mao, Zaiwang Li, Xinxin Li, Fengyun Wang, Tao Wang, Qingfang Yuan, Sunwei Wang, Mengjia Pu & Guangjun Xi

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  1. Jiaojie Hui
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  2. Jianping Zhang
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  3. Xuqiang Mao
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  4. Zaiwang Li
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Corresponding author

Correspondence to Guangjun Xi.

Ethics declarations

All study documents and procedures were approved by the Ethics Committees at all participating hospitals. All patients or their designated relatives gave their written informed consent prior to participation in this study. There was no delay in patients’ receiving treatment due to participation of the study.

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The authors declare that they have no conflict of interest.

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Hui, J., Zhang, J., Mao, X. et al. The initial glycemic variability is associated with early neurological deterioration in diabetic patients with acute ischemic stroke. Neurol Sci 39, 1571–1577 (2018). https://doi.org/10.1007/s10072-018-3463-6

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