| Increased severity of stroke |
More severe deficits in those with an admission glucose value >120 mg/dl (24 vs. 87% p <0.05) [5]. Greater final infarct size and worse functional outcome in hyperglycemic patients [6]. Elevated glucose is independently associated with infarct volume growth in all patients(p = 0.034), those without diabetes (p = 0.002), but not those with diabetes (p = 0.871) [4] Elevated glucose associated with neurological deterioration in all patients (OR 1.010; 95%CI 1.004–1.017), those without diabetes (OR 1.014; 95% CI 1.002–1.026), but not in those with diabetes (OR 1.006; 95% CI 0.998–1.014) [4] |
| Hemorrhagic conversion |
Odds of symptomatic ICH increased by 1.75 per 100 mg/dl of admission blood glucose regardless of rt-PA treatment (95% CI 1.11 to 2.78) [7]. Blood glucose levels greater than 180 mg/dl were independently associated with higher risk of intracerebral hemorrhage (OR 2.86; 95% CI 1.69–4.83) [8]. |
| Poor neurologic recovery |
Patients with diabetes recover more slowly despite having similar stroke severity scores [9]. Every 100 mg/dl increase in admission glucose was associated with a 24% reduction in odds of neurological improvement (95% CI 0.61 to 0.95) [10]. In those with admission glucose of ≥ 120 mg/dl only 43% were able to return to work compared with 76% who had lower glucose (p = 0.061) [5]. |
| Increased mortality |
Diagnosis of diabetes increased the relative risk of death by 1.8 (95% CI 1.04–3.19) Blood glucose greater than 120 mg/dl was associated with odds for mortality of 1.24 (95%CI 1.07–1.44) at 3 months [8]. Blood glucose >130 mg/dl independently increased the risk for death at 30 days (HR 1.87, p <0.01), 1 year (HR 1.75, p <0.01), and 6 years (HR 1.41, p <0.01) after stroke [11]. Mortality associated with admission glucose level 108 to 144 mg/d was RR 3.07 (95% CI, 2.50 to 3.79) in patients without diabetes and RR 1.30 in patients with diabetes [12]. |
