Quantifying the rate of blood glucose changes over the acute stage of ischemic stroke among patients with diabetes.
Marwa Elsaeed Elhefnawy, Norsima Sidek, Siti Maisharah Sheikh Ghadzi, Baharudin Ibrahim, Irene Looi, Zariah Abdul Aziz, Sabariah Noor Harun.
School of pharmaceutical sciences, Universiti Sains Malaysia
Objectives: Hyperglycemia (HG) during acute ischemic stroke (AIS) is associated with poor outcomes. Diabetes mellitus (DM) is an independent predictor for HG during acute ischemic stroke. The blood glucose progression and factors affecting its rate among patients with DM is not fully established. This study aimed to quantify the rate of blood glucose changes over the first 72 hours during AIS among patients with DM using a parametric approach.
Methods: The data of patients with HG during AIS admitted to Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu, Malaysia was extracted retrospectively. HG was defined as a blood glucose level > 7.8 mmol/l. The HG pattern was quantified via the development of disease progression model of HG during the first 72 hours of AIS. Linear and nonlinear disease progression models were tested on the data using NONMEM software version 7.5 through baseline model and covariate model development. The best model was selected using maximum likelihood estimation, clinical plausibility, the goodness of fit (GOF) and visual predictive checks (VPC).
Results: Among 243 patients with HG during AIS,182 (75%) had DM prior IS. Blood glucose was found to be 13.2 mmol/l at baseline, with the rate of decline over time (𝜶) equal to -0.085 mmol/l/day in the final developed disease progression linear model among patients with DM. In those who received antihyperlipidemic agents prior stroke, the baseline blood glucose decreased by 2.25 mmol/l/day. While the presence of hyperlipidemia (HPLD) prior to stroke was found to increase the rate of blood glucose progression by 0.0554, receiving betablockers before stroke increased the rate of blood glucose progression to 0.049.
Conclusions: The baseline blood glucose is decreased among DM patients who receiving antihyperlipidemic drugs prior stroke while, the presence of HPLD and receiving betablockers prior ischemic stroke increase the rate of blood glucose progression among DM patients who have HG during AIS. These findings may provide a rationale for keeping close monitoring for AIS patients and developing new strategies for treatment and follow up among these patients, shed light on the need for personalised therapy among IS patients.
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