This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Capes, S. E. Articles by Gerstein, H. C. Search for Related Content PubMed PubMed Citation Articles by Capes, S. E. Articles by Gerstein, H. C. Related Collections Type 1 diabetes Type 2 diabetes Glucose intolerance Acute Cerebral Hemorrhage Acute Cerebral Infarction Other Stroke Treatment - Medical

(Stroke. 2001;32:2426.)
© 2001 American Heart Association, Inc.

Comments, Opinions, and Reviews

Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients

A Systematic Overview

Sarah E. Capes, MD;; Dereck Hunt, MD, MSc;; Klas Malmberg, MD, PhD;; Parbeen Pathak, BSc, MD; Hertzel C. Gerstein, MD, MSc

From the Department of Medicine, McMaster University, Hamilton, Ontario, Canada (S.E.C., D.H., H.C.G.); Department of Cardiology, Karolinska Hospital, Stockholm, Sweden (K.M.); and William Osler Health Center, Toronto, Ontario, Canada (P.P.).

Reprint requests to Dr S.E. Capes, HHSC-McMaster Site, Room 3V51D, 1200 Main St W, Hamilton, Ontario L8N 3Z5, Canada. E-mail scapes{at}mcmaster.ca

	Abstract

Top Abstract Introduction Methods Results Discussion References

 
Background and Purpose— "Stress" hyperglycemia may be associated with increased mortality and poor recovery in diabetic and nondiabetic patients after stroke. A systematic review and meta-analysis of the literature relating acute poststroke glucose levels to the subsequent course were done to summarize and quantify this relationship.

Methods— A comprehensive literature search was done for cohort studies reporting mortality and/or functional recovery after stroke in relation to admission glucose level. Relative risks in hyperglycemic compared with normoglycemic patients with and without diabetes were calculated and meta-analyzed when possible.

Results— Thirty-two studies were identified; relative risks for prespecified outcomes were reported or could be calculated in 26 studies. After stroke of either subtype (ischemic or hemorrhagic), the unadjusted relative risk of in-hospital or 30-day mortality associated with admission glucose level >6 to 8 mmol/L (108 to 144 mg/dL) was 3.07 (95% CI, 2.50 to 3.79) in nondiabetic patients and 1.30 (95% CI, 0.49 to 3.43) in diabetic patients. After ischemic stroke, admission glucose level >6.1 to 7.0 mmol/L (110 to 126 mg/dL) was associated with increased risk of in-hospital or 30-day mortality in nondiabetic patients only (relative risk=3.28; 95% CI, 2.32 to 4.64). After hemorrhagic stroke, admission hyperglycemia was not associated with higher mortality in either diabetic or nondiabetic patients. Nondiabetic stroke survivors whose admission glucose level was >6.7 to 8 mmol/L (121 to 144 mg/dL) also had a greater risk of poor functional recovery (relative risk=1.41; 95% CI, 1.16 to 1.73).

Conclusions— Acute hyperglycemia predicts increased risk of in-hospital mortality after ischemic stroke in nondiabetic patients and increased risk of poor functional recovery in nondiabetic stroke survivors.

Key Words: hyperglycemia • glucose • meta-analysis • prognosis • stroke

	Introduction

Top Abstract Introduction Methods Results Discussion References

 
A high proportion of patients suffering an acute stress such as stroke¹ or myocardial infarction² may develop hyperglycemia, even in the absence of a preexisting diagnosis of diabetes. Both human and animal studies suggest that this is not a benign occurrence and that stress-induced hyperglycemia is associated with a high risk of mortality after both stroke³ and myocardial infarction.⁴ Moreover, recent evidence that glucose lowering with insulin reduces ischemic brain damage in animal models of stroke⁵ suggests that stress-induced hyperglycemia may be a modifiable risk factor for brain damage.

Despite these observations, the relationship between glucose levels and outcome after stroke in diabetic and nondiabetic patients has not been well characterized, and those studies that have examined this relationship have reported conflicting results. We therefore systematically reviewed the published literature to summarize the available evidence and to estimate the strength of the association between admission hyperglycemia and both short-term mortality and functional recovery after stroke.

	Methods

Top Abstract Introduction Methods Results Discussion References

 
Selection of Studies
A computerized literature search of MEDLINE (1966 to December 2000) was undertaken by 2 independent searchers, one of whom was assisted by a medical librarian experienced in literature searching. English-language articles reporting original data were eligible for inclusion in the study. Letters and review articles were perused for additional references but were not included in the meta-analysis. Search terms were obtained by noting recurrent words in the titles and abstracts of relevant articles known to the searchers. The subject headings blood glucose, stroke, cerebral infarction, cerebral hemorrhage, and cerebral ischemia and text words hyperglycemia, euglycemia, and hypoglycemia were combined with epidemiological terms (including the subject headings incidence, mortality, follow-up studies, cohort studies, and prognosis and text words natural history, course, and predict) in a strategy devised to maximize the sensitivity of the search.⁶

In addition, a computerized search of Science Citation Index from 1980 to December 1999 was used to retrieve all articles citing any 1 of 7 key studies.^1,7–12 Titles, abstracts, and/or the full text of articles retrieved from the Science Citation Index search were also assessed for relevance. The bibliographies of all relevant articles were searched by hand for additional articles, and experts in the field were contacted to identify any additional citations.

The full text of all articles thought to be potentially relevant by either of the 2 searchers was obtained. The authors and their institution, funding, the source of the article, and any acknowledgments were then deleted from all retrieved articles, and the resulting modified text was assessed independently for relevance by the 2 searchers.

An article was considered relevant to the overview if it was a cohort study or clinical trial of patients admitted with stroke, in which a baseline blood glucose level had been drawn within 24 hours of admission and in which outcomes (mortality within 1 month of the event or functional recovery from stroke) were reported according to the admission blood glucose level. Agreement between the 2 searchers on selection of relevant studies was measured, and any disagreements were resolved by consensus.

Inclusion and Exclusion Criteria
Studies retrieved by the literature search were included in the overview if they (1) assembled and prospectively followed an inception cohort, (2) explicitly stated that blood glucose was drawn within 24 hours of admission, (3) reported follow-up of 80% to hospital discharge or to 1 month, and (4) reported outcomes according to admission glucose level, as described above. Studies reporting exclusively on subarachnoid hemorrhage, transient ischemic attack, and nonstroke causes of focal neurological deficits were excluded. Studies that did not explicitly report the proportion of patients followed up or the timing of blood glucose measurement were also excluded.

Definition of Diabetes and Hyperglycemia
Patients were considered to be diabetic if they were classified as diabetic by the authors of the individual studies. The definition of hyperglycemia or "stress" hyperglycemia used was the one adopted by the authors of the individual studies and therefore varied from study to study.

Statistical Analysis
We calculated coefficients for agreement between the 2 observers on the inclusion of studies. The relative risk and 95% CI for mortality or functional recovery in hyperglycemic versus nonhyperglycemic patients after stroke were calculated for each study when possible. Relative risks were calculated separately for diabetic and nondiabetic patients when possible. The approach of DerSimonian and Laird¹³ (random-effects model) was used to generate a summary estimate of relative risk. Statistical heterogeneity among the studies was assessed by a ² test.

	Results

Top Abstract Introduction Methods Results Discussion References

 
Search Results
The 2 MEDLINE searches yielded 308 citations. From the titles and/or abstracts, 45 citations were thought to be potentially relevant by 1 or both of the reviewers (=0.93 for agreement between the 2 reviewers), and the full texts of these articles were retrieved. After review of the full text, 32 articles from the MEDLINE search were considered relevant (=0.78). Two additional relevant articles were found by searching the bibliographies; the Science Citation Index search yielded 5 additional relevant articles.

Selection of Studies
Eight of 39 relevant articles were excluded from the final analysis because of methodological and reporting issues: the completeness of follow-up was not reported in 4 articles,^14–17 the timing of blood glucose measurement could not be determined in 2 articles,^18,19 1 article was excluded because patients formed part of a larger cohort reported in another article,²⁰ and in 1 article the length of follow-up was insufficient to demonstrate the relevant outcomes (patients were followed for only 5 hours after stroke).²¹ Thirty-one articles describing 32 cohort studies (1 article described 2 separate cohorts²²) therefore were included in the overview.^{1,7–12,22–45}

Description of Studies
In 27 of the 32 studies, patients were enrolled and data were collected before outcomes had occurred. In the remainder, data were collected after outcomes had occurred. All of the included studies reported at least 80% complete follow-up to hospital discharge; 10 of the 32 studies also reported long-term follow-up (3 months to 1 year after stroke).^{8,12,22,27,29–32,37}

All studies included patients who had CT scan evidence of stroke and/or who met minimum World Health Organization criteria for the diagnosis of stroke (ie, rapidly developing focal neurological deficit lasting >24 hours or leading to death attributable to vascular causes⁴⁶). Four of the 32 studies presented data separately for patients with ischemic versus hemorrhagic stroke,^1,25,32,36 and 11 studies included only patients with ischemic stroke (thromboembolic and/or lacunar).^* The remaining studies included only patients with hemorrhagic stroke,^34,40,42 combined data for patients with ischemic and hemorrhagic stroke, or did not state the stroke subtype in included patients.^8,28

Functional recovery from stroke was reported in 13 of the 32 studies. The assessment was based on a validated scale (Barthel Index,^10,23,45 Glasgow Outcome Scale,^37,45 Canadian Stroke Scale,²⁴ and Canadian Neurological Scale²⁵) in 6 of these studies. The remainder used the following qualitative descriptions of poor functional recovery: unable to return to any form of work,⁷ persistent disability,²⁶ need for residential placement,²⁷ dependent in activities of daily living,^11,22,28 and stable deficit with no recovery.²⁹

Diabetes status was assigned on the basis of a history of diabetes or treatment with hypoglycemic agents in 20 of 32 studies; in 8 studies, an elevated glycosylated hemoglobin^{8,12,23,32,35,37} or persistent or marked hyperglycemia^10,25 was used to define diabetes. The definition of diabetes was not specified in 1 study,²⁸ and 3 studies excluded patients with diabetes.^7,11,39

The definition of stress hyperglycemia also varied among studies. Most studies did not specify whether whole blood or plasma glucose was measured. Of those that did specify, 1 study measured whole blood glucose,³⁷ and the rest measured plasma glucose levels. A random glucose level drawn on admission was used to define stress hyperglycemia in 10 of the 32 studies (with cutoffs ranging from 6 to 10 mmol/L [108 to 180 mg/dL]).^|| Another 9 studies based the definition of stress hyperglycemia on fasting glucose level the morning after admission (ranging from 6.1 to 7.8 mmol/L [110 to 141 mg/dL])^{1,9,22–25,32,35–36}. Two of the 32 studies did not specify whether the glucose level used to define stress hyperglycemia in individual patients was random or fasting.^27,37 The remaining 11 of 32 studies did not identify the glucose cutoffs used to define stress hyperglycemia^{10,11,28,38–45}; these studies reported either the mean glucose level in patients with good versus poor outcomes or the relationship between outcomes and glucose as a continuous variable on regression analysis.

Relationship Between Admission Glucose Level and Outcomes
Table 1 shows the unadjusted relative risk of short-term mortality (before discharge from the hospital or within 1 month of stroke) associated with stress hyperglycemia after stroke of either subtype, which was calculated from data reported in 12 studies.^{1,9,12,23,25,30–36} In patients without diabetes, stress hyperglycemia was associated with a 3-fold increased risk of mortality after stroke (pooled relative risk, 3.07; 95% CI, 2.50 to 3.79). In patients with diabetes, stress hyperglycemia was not associated with a significantly higher risk of short-term mortality after stroke (pooled relative risk, 1.30; 95% CI, 0.49 to 3.43).

View this table: [in this window] [in a new window]   Table 1.  Relative Risk of In-Hospital or 30-Day Mortality Associated With Stress Hyperglycemia in Patients With Stroke

A planned exploratory analysis by stroke subtype was done (Figure). This analysis was restricted to 4 studies in which separate mortality data for ischemic and hemorrhagic stroke were reported. It included 682 patients with ischemic stroke (88 of whom were diabetic) and 98 patients with hemorrhagic stroke (9 of whom were diabetic). After ischemic stroke, nondiabetic patients with admission glucose level >6.1 to 7.0 mmol/L (110 to 126 mg/dL) had a 3.28-fold higher risk of short-term mortality (95% CI, 2.32 to 4.64). In patients with diabetes and ischemic stroke, the pooled relative risk associated with stress hyperglycemia was 2.00 (95% CI, 0.04 to 90.08). In contrast, stress hyperglycemia was not significantly associated with short-term mortality after hemorrhagic stroke. In nondiabetic patients, the relative risk of short-term mortality after hemorrhagic stroke was 2.43 (95% CI, 0.68 to 8.73); there were insufficient data to calculate the corresponding relative risk in diabetic patients with hemorrhagic stroke.

View larger version (15K): [in this window] [in a new window]   Unadjusted relative risk of in-hospital or 30-day mortality after stroke in patients with stress hyperglycemia compared with those without stress hyperglycemia. Data are shown for the 4 studies that reported separate mortality data for ischemic and hemorrhagic stroke in nondiabetic and/or diabetic patients. Ovals and bars represent relative risk and 95% CI for individual studies. Rectangles and bars represent pooled relative risk and 95% CI, derived by pooling data from the individual studies. Def’n indicates definition.

The 10 studies that reported long-term mortality (3 months to 1 year) after stroke^{8,12,22,27,29–32,37} could not be pooled because they were statistically heterogeneous (P<0.05 for homogeneity). These studies combined data for diabetic and nondiabetic patients, and many included patients with both hemorrhagic and ischemic stroke. The studies differed in duration of follow-up, number of diabetic patients, and number of patients with each stroke subtype. Stress hyperglycemia was associated with a significantly increased risk of long-term mortality in 5 of these 10 studies^{12,22,27,31,32} (data not shown).

Table 2 shows the unadjusted relative risk of poor functional recovery associated with stress hyperglycemia, which could be calculated from data in 8 studies.^{7,22,23,25–27,29,37} Stress hyperglycemia on admission was associated with poor functional recovery up to 6 months after stroke in nondiabetic patients (pooled unadjusted relative risk of poor functional recovery=1.41; 95% CI, 1.16 to 1.73). Data on stroke recovery in diabetic patients were not reported.

View this table: [in this window] [in a new window]   Table 2.  Relative Risk of Poor Functional Recovery Associated With Stress Hyperglycemia in Survivors of Stroke

Twelve of the 32 studies did not report sufficient data to allow calculation of the unadjusted relative risk of outcomes in patients with and without stress hyperglycemia. Data from these studies therefore could not be included in the quantitative meta-analysis. Six of these 12 studies performed a multivariate analysis to explore the relationship between glucose level and poor outcomes. The largest of these 12 studies analyzed data from a stroke registry that included 1776 patients with ischemic stroke and 355 patients with hemorrhagic stroke, 83% of whom were nondiabetic. In both stroke subtypes combined, admission glucose level was a significant predictor of mortality independent of other prognostic factors (odds ratio=1.007; 95% CI, 1.004 to 1.01).⁴⁴ Another large study included 1259 patients with ischemic stroke (71% of whom were nondiabetic) enrolled in a clinical trial of a low-molecular-weight heparinoid versus placebo. It showed that the odds of a poor functional recovery at 3 months increased by 22% for each 100-mg/dL increase in admission glucose level after adjustment for confounders (P=0.03).⁴⁵ Of the 4 smaller studies performing multivariate analyses, 1 found glucose level to be an independent predictor of mortality in patients with ischemic stroke,²⁴ 1 enrolled only patients with hemorrhagic stroke and did not show this association,⁴⁰ and the other 2 studies did not identify glucose level as an independent predictor of mortality at 30 days³⁸ or 3 months³⁹ in a mixed population of patients with ischemic and hemorrhagic stroke. The remaining 6 of the 12 studies reported only the mean glucose level in patients with a poor outcome (death or poor functional recovery) compared with those with a good outcome.^{10,11,28,41–43} Patients who experienced a poor outcome tended to have higher glucose levels than those with a good outcome.

	Discussion

Top Abstract Introduction Methods Results Discussion References

 
This systematic overview shows that in patients with no history of diabetes who have an ischemic stroke, even moderately elevated glucose levels are associated with both a 3-fold higher risk of short-term mortality and an increased risk of poor functional recovery compared with lower glucose levels. This finding is supported by studies showing higher mean admission glucose level in nonsurvivors of stroke compared with survivors.^10,38–43 It is also supported by multivariate analyses of data from 2 large studies, in which admission glucose level was a significant predictor of mortality⁴⁴ or poor functional recovery⁴⁵ after stroke independent of other prognostic factors.

Several explanations may account for the observed association between hyperglycemia and poor prognosis after ischemic stroke. First, hyperglycemia may be directly toxic to the ischemic brain. Although the mechanism is not fully understood, accumulation of lactate and intracellular acidosis in the ischemic brain (produced through anaerobic cerebral glucose metabolism)⁴⁷ may contribute. Intracellular acidosis may promote and accelerate ischemic injury by enhancing lipid peroxidation and free radical formation,⁴⁸ allowing accumulation of intracellular calcium⁴⁹ (a key component of the glutamate-dependent excitotoxicity seen in ischemic neurons⁵⁰), and impairing mitochondrial function.⁵¹ These neurotoxic effects may be particularly important in the ischemic penumbra (the region of brain tissue surrounding the core of infarcted tissue where neurons are injured but still viable⁵²). Indeed, in an animal model of stroke, hyperglycemia facilitated the development of cellular acidosis in the ischemic penumbra and resulted in a greater infarct volume compared with insulin-treated hypoglycemic animals.⁵¹ Thus, hyperglycemia may promote the recruitment of potentially salvageable neurons into the infarction.

Second, hyperglycemic patients are relatively deficient in insulin. This leads to both reduced peripheral uptake of glucose (increasing the amount of glucose available to diffuse into brain) and increased circulating free fatty acids. Free fatty acids may impair endothelium-dependent vasodilation⁵³ and, in hyperglycemic patients with acute myocardial infarction, have been shown to promote calcium overload and arrhythmias⁵⁴; however, the effect of excessive circulating free fatty acids on ischemic brain has not been studied.

Third, patients without a diagnosis of diabetes who develop stress hyperglycemia are likely to have dysglycemia (ie, blood glucose level above the normal range but below the threshold for diabetes⁵⁵) or undiagnosed diabetes when not stressed. Patients with dysglycemia or undiagnosed diabetes have a higher risk of vascular disease than patients with normal blood glucose level.⁵⁶ These patients could sustain more ischemic damage at the time of infarction as a result of more extensive underlying cerebral vasculopathy compared with those who do not develop stress hyperglycemia. Although the extent of cerebral atherosclerosis in patients with and without stress hyperglycemia has not been studied, hyperglycemia may be an important determinant of the widespread changes in both small cerebral blood vessels⁵⁷ and large extracranial vessels⁵⁸ seen in diabetic patients. Furthermore, even nondiabetic-range hyperglycemia is associated with endothelial dysfunction,⁵⁹ another potential mechanism of cerebrovascular disease in these patients. Patients with dysglycemia or undiagnosed diabetes may also have a higher risk of cardiac events after stroke; however, the available evidence suggests that most of the excess mortality in patients with stress hyperglycemia is due to the neurological effect of the large stroke^25,35 and not to a higher fatal cardiac event rate.

Fourth, hyperglycemia may disrupt the blood-brain barrier⁶⁰ and promote hemorrhagic infarct conversion.⁶¹ Consistent with this possibility is the observation that in 138 diabetic and nondiabetic patients with ischemic stroke treated with intravenous recombinant tissue plasminogen activator, higher admission serum glucose level was associated with a higher risk of hemorrhagic conversion of the infarct, with a substantial increase in risk with levels >8.4 mmol/L.⁶² This study did not report mortality or functional recovery from stroke in relation to admission glucose level and therefore was not included in this overview. Only 1 study included in the overview reported the risk of hemorrhagic infarct conversion in relation to glucose level. This study followed 1259 patients with ischemic stroke randomized to a low-molecular-weight heparinoid versus placebo⁴⁵; in the 2 groups combined, there was no association between admission glucose level and risk of hemorrhagic infarct conversion. The reason for the discrepancy between these 2 studies is not clear.

Fifth, stress hyperglycemia may be a marker of the extent of ischemic damage in patients with stroke. For example, patients with severe or fatal strokes might develop hyperglycemia because of greater release of "stress hormones" such as cortisol and norepinephrine. Indeed, a logistic regression analysis of data from 345 patients with stroke showed that the strength of the positive association between hyperglycemia and mortality lessened after accounting for the severity of stroke (as indicated by decreased level of consciousness and weakness score at the onset of stroke).³⁸ However, animal studies showing that administration of insulin reduces the size of the infarct and improves prognosis after stroke^5,51 strongly support the view that stress hyperglycemia is of pathophysiological significance in patients with stroke and is not simply an epiphenomenon of the stress response to stroke.

Whereas many studies have shown that diabetes increases the risk of mortality after stroke, few have explored the relationship between admission hyperglycemia and prognosis after stroke in diabetic patients. This review did not find evidence that admission hyperglycemia increases the risk of mortality within a month of ischemic stroke in diabetic patients. The discrepancy between this finding and the strong association between stress hyperglycemia and mortality in nondiabetic patients with ischemic stroke may be due to several reasons. First, the number of diabetic patients in the studies included in this overview was small, resulting in low power to detect the same relative risk in diabetic patients as in nondiabetic patients. Second, the threshold values that defined hyperglycemia in the individual studies may have been too low to distinguish between diabetic patients with and without stress hyperglycemia. Third, the definition of stress hyperglycemia is intrinsically problematic in diabetic patients because the unstressed baseline level of glucose is not known. Fourth, diabetic patients are more likely to receive therapy for hyperglycemia. Glucose-lowering therapy would reduce the amount of glucose available to diffuse into brain and might reduce cerebral lactic acidosis and other harmful metabolic changes in the brain. Furthermore, if insulin were used, this might also limit the extent of the infarct through anticoagulant effects such as reduced thromboxane production⁶³ and decreased plasminogen activator inhibitor-1 activity.⁶⁴ The use of glucose-lowering therapy (including insulin) in patients with stress hyperglycemia could not be assessed in the studies included in this overview.

The results of this overview are limited by several factors: the pooled studies differed in inclusion and exclusion criteria, definition of hyperglycemia, and concomitant treatment; relative risks included in the meta-analysis were not adjusted for other prognostic factors; and only published studies were included. Nevertheless, the strong and consistent association between admission hyperglycemia and poor prognosis after stroke observed in nondiabetic patients suggests that glucose level is an important risk factor for morbidity and mortality after stroke. These results highlight the need for further research to determine whether glucose lowering at the time of stroke can improve outcomes; at least 1 clinical trial to address this question is already under way.⁶⁵

	Footnotes

 
*References ^{7, 10, 22, 24, 26, 29–31, 41, 45}.

References ^{9, 11, 12, 23, 27, 33, 35, 37–39, 43, 44}.

References ^{1, 9, 22, 24, 26, 27, 29–31, 33, 34, 36, 38, 40–45}.

References ^{7, 11, 12, 22, 24, 28, 30–32, 36, 38, 40–42, 44, 45}.

||References ^{7, 8, 12, 22, 26, 29–31, 33, 34}.

Received January 13, 2001; accepted July 4, 2001.

	References

Top Abstract Introduction Methods Results Discussion References

 
1. Melamed E. Reactive hyperglycaemia in patients with acute stroke. J Neurol Sci. . 1976; 29: 267–275.[Medline] [Order article via Infotrieve]

2. Sewdarsen M, Jialal I, Vythilingum S, Govender G, Rajput MC. Stress hyperglycaemia is a predictor of abnormal glucose tolerance in Indian patients with acute myocardial infarction. Diabetes Res. . 1987; 6: 47–49.[Medline] [Order article via Infotrieve]

3. Mankovsky BN, Metzger BE, Molitch ME, Biller J. Cerebrovascular disorders in patients with diabetes mellitus. J Diabetes Complications. . 1996; 10: 228–242.[Medline] [Order article via Infotrieve]

4. Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. . 2000; 355: 773–778.[Medline] [Order article via Infotrieve]

5. Hamilton MG, Tranmer BI, Auer RN. Insulin reduction of cerebral infarction due to transient focal ischemia. J Neurosurg. . 1995; 82: 262–268.[Medline] [Order article via Infotrieve]

6. McKibbon KA, Walder-Dilks C, Haynes RB, Wilczynski N. Beyond ACP Journal Club: how to harness MEDLINE for prognosis problems. ACP J Club. . 1995; 123: A12–A14.[Medline] [Order article via Infotrieve]

7. Pulsinelli WA, Levy DE, Sigsbee B, Scherer P, Plum F. Increased damage after ischemic stroke in patients with hyperglycemia with or without established diabetes mellitus. Am J Med. . 1983; 74: 540–544.[Medline] [Order article via Infotrieve]

8. Cox NH, Lorains JW. The prognostic value of blood glucose and glycosylated haemoglobin estimation in patients with stroke. Postgrad Med J. . 1986; 62: 7–10.[Abstract/Free Full Text]

9. Candelise L, Landi G, Orazio EN, Boccardi E. Prognostic significance of hyperglycemia in acute stroke. Arch Neurol. . 1985; 42: 661–663.[Abstract/Free Full Text]

10. Woo E, Chan YW, Yu YL, Huang CY. Admission glucose level in relation to mortality and morbidity outcome in 252 stroke patients. Stroke. . 1988; 19: 185–191.[Abstract/Free Full Text]

11. O’Neill PA, Davies I, Fullerton KJ, Bennett D. Stress hormone and blood glucose response following acute stroke in the elderly. Stroke. . 1991; 22: 842–847.[Abstract/Free Full Text]

12. Gray CS, French JM, Bates D, Cartlidge NEF, Venables GF, James OFW. Increasing age, diabetes mellitus and recovery from stroke. Postgrad Med J. . 1989; 65: 720–724.[Abstract/Free Full Text]

13. DerSimonian R, Laird NM. Meta-analysis in clinical trials. Control Clin Trials. . 1986; 7: 177–188.[Medline] [Order article via Infotrieve]

14. Dyker AG, Weir CJ, Lees KR. Influence of cholesterol on survival after stroke: retrospective study. BMJ. . 1997; 314: 1584–1588.[Abstract/Free Full Text]

15. Toni D, De Michele M, Fiorelli M, Bastianello S, Camerlingo M, Sacchetti ML, Argentino C, Fieschi C. Influence of hyperglycaemia on infarct size and clinical outcome of acute ischemic stroke patients with intracranial arterial occlusion. J Neurol Sci. . 1994; 123: 129–133.[Medline] [Order article via Infotrieve]

16. Abu-Zeid HAH, Choi NW, Hsu P-H, Maini KK. Prognostic factors in the survival of 1,484 stroke cases observed for 30 to 48 months. Arch Neurol. . 1978; 35: 121–125.[Abstract/Free Full Text]

17. Woo E, Ma JT, Robinson JD, Yu YL. Hyperglycemia is a stress response in acute stroke. Stroke. . 1988; 19: 1359–1364.[Abstract/Free Full Text]

18. Finocchi C, Gandolfo C, Gasparetto B, Del Sette M, Croce R, Loeb C. Value of early variables as predictors of short-term outcome in patients with acute focal cerebral ischemia. Ital J Neurol Sci. . 1996; 17: 341–346.[Medline] [Order article via Infotrieve]

19. D’Olhaberriague L, Espadaler Gamissans JM, Marrugat J, Valls A, Oliveras Ley C, Seoane JL. Transcranial magnetic stimulation as a prognostic tool in stroke. J Neurol Sci. . 1997; 147: 73–80.[Medline] [Order article via Infotrieve]

20. Gray CS, Taylor R, French JM, Alberti KGMM, Venables GS, James OFW, Shaw DA, Cartlidge NEF, Bates D. The prognostic value of stress hyperglycaemia and previously unrecognized diabetes in acute stroke. Diabetes Med. . 1987; 4: 237–240.[Medline] [Order article via Infotrieve]

21. Horowitz SH, Zito JL, Donnarumma R, Patel M, Alvir J. Clinical-radiologic correlations within the first 5 hours of cerebral infarction. Acta Neurol Scand. . 1992; 86: 207–214.[Medline] [Order article via Infotrieve]

22. Power MJ, Fullerton KJ, Stout RW. Blood glucose and prognosis of acute stroke. Age Ageing. . 1988; 17: 164–170.[Abstract/Free Full Text]

23. Woo J, Lam CWK, Kay R, Wong AHY, Teoh R, Nicholls MG. The influence of hyperglycemia and diabetes mellitus on immediate and 3-month morbidity and mortality after acute stroke. Arch Neurol. . 1990; 47: 1174–1177.[Abstract/Free Full Text]

24. Davalos A, Fernandez-Real JM, Ricart W, Soler S, Molins A, Planas E, Genis D. Iron-related damage in acute ischemic stroke. Stroke. . 1994; 25: 1543–1546.[Abstract]

25. Toni D, Sacchetti ML, Argentino C, Gentile M, Cavalletti C, Frontoni M, Fieschi C. Does hyperglycaemia play a role on the outcome of acute ischaemic stroke patients? J Neurol. . 1992; 239: 382–386.[Medline] [Order article via Infotrieve]

26. Kushner M, Nencini P, Reivich M, Rango M, Jamieson D, Fazekas F, Zimmerman R, Chawluk J, Alavi A, Alves W. Relation of hyperglycemia early in ischemic brain infarction to cerebral anatomy, metabolism, and clinical outcome. Ann Neurol. . 1990; 28: 129–135.[Medline] [Order article via Infotrieve]

27. Weir CJ, Murray GD, Dyker AG, Lees KR. Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long term follow up study. BMJ. . 1997; 314: 1303–1306.[Abstract/Free Full Text]

28. Fullerton KJ, Mackenzie G, Stout RW. Prognostic indices in stroke. Q J Med. . 1988; 66: 147–162.[Abstract/Free Full Text]

29. Adams HP Jr, Olinger CP, Marler JR, Biller J, Brott TG, Barsan WG, Banwart K. Comparison of admission serum glucose concentration with neurologic outcome in acute cerebral infarction: a study in patients given naloxone. Stroke. . 1988; 19: 455–458.[Abstract/Free Full Text]

30. Matchar DB, Divine GW, Heyman A, Feussner JR. The influence of hyperglycemia on outcome of cerebral infarction. Ann Intern Med. . 1992; 117: 449–456.

31. Sacco RL, Shi T, Zamanillo MC, Kargman DE. Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: the Northern Manhattan Stroke Study. Neurology. . 1994; 44: 626–634.[Abstract/Free Full Text]

32. Lee T-H, Ryu S-J, Chen S-T. The prognostic value of blood glucose in patients with acute stroke. J Formos Med Assoc. . 1991; 90: 456–470.

33. Stig-Jørgensen H, Nakayama H, Raaschou HO, Olsen TS. Stroke in patients with diabetes: the Copenhagen Stroke Study. Stroke. . 1994; 25: 1977–1984.[Abstract]

34. Tuhrim S, Dambrosia JM, Price TR, Mohr JP, Wolf PA, Hier DB, Kase CS. Intracerebral hemorrhage: external validation and extension of a model for prediction of 30-day survival. Ann Neurol. . 1991; 29: 658–663.[Medline] [Order article via Infotrieve]

35. Kiers I, Davis SM, Larkins R, Hopper J, Tress B, Rossiter SC, Carlin J, Ratnaike S. Stroke topography and outcome in relation to hyperglycaemia and diabetes. J Neurol Neurosurg Psychiatry. . 1992; 55: 263–270.[Abstract/Free Full Text]

36. Cazzato G, Zorzon M, Mase G, Iona LG. Hyperglycemia at ischemic stroke onset as prognostic factor. J Neurol Sci. . 1991; 12: 283–288.

37. van Kooten F, Hoogerbrugge N, Naarding P, Koudstaal PJ. Hyperglycemia in the acute phase of stroke is not caused by stress. Stroke. . 1993; 24: 1129–1132.[Abstract/Free Full Text]

38. Czlonkowska A, Ryglewicz D, Lechowicz W. Basic analytical parameters as the predictive factors for 30-day case fatality rate in stroke. Acta Neurol Scand. . 1997; 95: 121–124.[Medline] [Order article via Infotrieve]

39. Tracey F, Crawford VLS, Lawson JT, Buchanan KD, Stout RW. Hyperglycaemia and mortality from acute stroke. Q J Med. . 1993; 86: 439–446.[Abstract/Free Full Text]

40. Mase G, Zorzon M, Biasutti E, Tasca G, Vitrani B, Cazzato G. Immediate prognosis of primary intracerebral hemorrhage using an easy model for the prediction of survival. Acta Neurol Scand. . 1995; 91: 306–309.[Medline] [Order article via Infotrieve]

41. Murros K, Fogelholm R, Kettunen S, Vuorela A-L, Valve J. Blood glucose, glycosylated haemoglobin, and outcome of ischemic brain infarction. J Neurol Sci. . 1992; 111: 59–64.[Medline] [Order article via Infotrieve]

42. Poungvarin N, Viriyavejakul A. Spontaneous supratentorial intracerebral haemorrhage: a prognostic study. J Med Assoc Thai. . 1990; 73: 206–210.[Medline] [Order article via Infotrieve]

43. M’Buyamba-Kabangu J-R, Longo-Mbenza B, Tambwe MJ, Dikassa LN, Mbala-Mukendi M. J-shaped relationship between mortality and admission blood pressure in black patients with acute stroke. J Hypertens. . 1995; 13: 1863–1868.[Medline] [Order article via Infotrieve]

44. Moulin T, Tatu L, Crepin-Leblond T, Chavot D, Berges S, Rumbach L. The Besançon Stroke Registry: an acute stroke registry of 2500 consecutive patients. Eur Neurol. . 1997; 38: 10–20.[Medline] [Order article via Infotrieve]

45. Bruno A, Biller J, Adams HP, Clarke WR, Woolson RF, Williams LS, Hansen MD, for the TOAST Investigators. Acute blood glucose level and outcome from ischemic stroke. Neurology. . 1999; 52: 280–284.[Abstract/Free Full Text]

46. Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strasser T. Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ. . 1980; 58: 113–130.[Medline] [Order article via Infotrieve]

47. Levine SR, Welch KM, Helpern JA, Chopp M, Bruce R, Selwa J, Smith MB. Prolonged deterioration of ischemic brain energy metabolism and acidosis associated with hyperglycemia: human cerebral infarction studied by serial 31P NMR spectroscopy. Ann Neurol. . 1988; 23: 416–418.[Medline] [Order article via Infotrieve]

48. Siesjö BK, Bendek G, Koide T, Westerberg E, Wieloch T. Influence of acidosis on lipid peroxidation in brain tissues in vitro. J Cereb Blood Flow Metab. . 1985; 5: 253–258.[Medline] [Order article via Infotrieve]

49. Ou Yang YB, Mellergård P, Kristián T, Kristiánova V, Siesjö BK. Influence of acid-base changes on the intracellular calcium concentration of neurons in primary culture. Exp Brain Res. . 1994; 101: 265–271.[Medline] [Order article via Infotrieve]

50. Choi DW, Rothman SM. The role of glutamate neurotoxicity in hypoxic-ischemic neuronal death. Ann Rev Neurosci. . 1990; 13: 171–182.[Medline] [Order article via Infotrieve]

51. Anderson RE, Tan WK, Martin HS, Meyer FB. Effects of glucose and PaO₂ modulation on cortical intracellular acidosis, NADH redox state, and infarction in the ischemic penumbra. Stroke. . 1999; 30: 160–170.[Abstract/Free Full Text]

52. Olsen TS, Larsen B, Herning M, Skriver EB, Lassen NA. Blood flow and vascular reactivity in collaterally perfused brain tissue: evidence of an ischemic penumbra in patients with acute stroke. Stroke. . 1983; 14: 332–341.[Abstract/Free Full Text]

53. Steinberg HO, Tarshoby M, Monestel R, Hook G, Cronin J, Johnson A, Bayazeed B, Baron AD. Elevated circulating free fatty acid levels impair endothelium-dependent vasodilation. J Clin Invest. . 1997; 100: 1230–1239.[Medline] [Order article via Infotrieve]

54. Oliver MF, Opie LH. Effects of glucose and fatty acids on myocardial ischaemia and arrhythmias. Lancet. . 1994; 343: 155–158.[Medline] [Order article via Infotrieve]

55. Gerstein HC, Yusuf S. Dysglycaemia and risk of cardiovascular disease. Lancet. . 1996; 347: 949–950.[Medline] [Order article via Infotrieve]

56. Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events: a metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care. . 1999; 22: 233–240.[Abstract/Free Full Text]

57. Alex M, Baron EK, Goldenberg S, Blumenthal HT. An autopsy study of cerebrovascular accident in diabetes mellitus. Circulation. . 1962; 25: 663–673.[Abstract/Free Full Text]

58. Salonen R, Salonen JT. Determinants of carotid intima media thickness: a population based ultrasonography study in eastern Finnish men. J Intern Med. . 1991; 229: 225–231.[Medline] [Order article via Infotrieve]

59. Vehkavaara S, Seppälä-Lindroos A, Westerbacka J, Groop P-H, Yki-Järvinen H. In vivo endothelial-dysfunction characterizes patients with impaired fasting glucose. Diabetes Care. . 1999; 22: 2055–2060.[Abstract/Free Full Text]

60. Dietrich WD, Alonso O, Busto R. Moderate hyperglycemia worsens acute blood-brain barrier injury after forebrain ischemia in rats. Stroke. . 1993; 24: 111–116.[Abstract/Free Full Text]

61. DeCourten-Myers GM, Kleinholz M, Holm P, DeVoe G, Schmitt G, Wagner KR, Myers RE. Hemorrhagic infarct conversion in experimental stroke. Ann Emerg Med. . 1992; 21: 121–126.

62. Demchuk AM, Morgenstern LB, Krieger DW, Chi TL, Hu W, Wein TH, Hardy RJ, Grotta JC, Buchan AM. Serum glucose level and diabetes predict tissue plasminogen activator–related intracerebral hemorrhage in acute ischemic stroke. Stroke. . 1999; 30: 34–39.[Abstract/Free Full Text]

63. Davi G, Catalano I, Averna M, Notarbartolo A, Strano A, Ciabattoni G, Patrono C. Thromboxane biosynthesis and platelet function in type II diabetes mellitus. N Engl J Med. . 1990; 322: 1769–1774.[Abstract]

64. Jain SK, Nagi DK, Slavin BM, Lumb PJ, Yudkin JS. Insulin therapy in type 2 diabetic patients suppresses plasminogen activator inhibitor (PAI-1) activity and proinsulin-like molecules independently of glycaemic control. Diabetes Med. . 1993; 10: 27–32.[Medline] [Order article via Infotrieve]

65. Scott JF, Robinson GM, French JM, O’Connell JE, Alberti KG, Gray CS. Glucose potassium insulin infusions in the treatment of acute stroke patients with mild to moderate hyperglycemia: the Glucose Insulin in Stroke Trial (GIST). Stroke. . 1999; 30: 793–799.[Abstract/Free Full Text]

This article has been cited by other articles:

				A. Turchin, M. E. Matheny, M. Shubina, J. V. Scanlon, B. Greenwood, and M. L. Pendergrass Hypoglycemia and Clinical Outcomes in Patients With Diabetes Hospitalized in the General Ward Diabetes Care, July 1, 2009; 32(7): 1153 - 1157. [Abstract] [Full Text] [PDF]

				M. H. Marchant Jr., N. A. Viens, C. Cook, T. P. Vail, and M. P. Bolognesi The Impact of Glycemic Control and Diabetes Mellitus on Perioperative Outcomes After Total Joint Arthroplasty J. Bone Joint Surg. Am., July 1, 2009; 91(7): 1621 - 1629. [Abstract] [Full Text] [PDF]

				A. J. Bree, E. C. Puente, D. Daphna-Iken, and S. J. Fisher Diabetes increases brain damage caused by severe hypoglycemia Am J Physiol Endocrinol Metab, July 1, 2009; 297(1): E194 - E201. [Abstract] [Full Text] [PDF]

				R. J. Comi Glucose Control in the Intensive Care Unit: A Roller Coaster Ride or a Swinging Pendulum? Ann Intern Med, June 2, 2009; 150(11): 809 - 811. [Abstract] [Full Text] [PDF]

				E. S. Moghissi, M. T. Korytkowski, M. DiNardo, D. Einhorn, R. Hellman, I. B. Hirsch, S. E. Inzucchi, F. Ismail-Beigi, M. S. Kirkman, and G. E. Umpierrez American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control Diabetes Care, June 1, 2009; 32(6): 1119 - 1131. [Full Text] [PDF]

				N. D. Kruyt, G. J. Biessels, R. J. de Haan, M. Vermeulen, G. J.E. Rinkel, B. Coert, and Y. B.W.E.M. Roos Hyperglycemia and Clinical Outcome in Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis Stroke, June 1, 2009; 40(6): e424 - e430. [Abstract] [Full Text] [PDF]

				C. S. Kidwell, K. R. Lees, K. W. Muir, C. Chen, S. M. Davis, D. A. De Silva, C. J. Weir, S. Starkman, J. R. Alger, J. L. Saver, et al. Results of the MRI Substudy of the Intravenous Magnesium Efficacy in Stroke Trial Stroke, May 1, 2009; 40(5): 1704 - 1709. [Abstract] [Full Text] [PDF]

				D. E.G. Griesdale, R. J. de Souza, R. M. van Dam, D. K. Heyland, D. J. Cook, A. Malhotra, R. Dhaliwal, W. R. Henderson, D. R. Chittock, S. Finfer, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data Can. Med. Assoc. J., April 14, 2009; 180(8): 821 - 827. [Abstract] [Full Text] [PDF]

				M. Kosiborod, S. E. Inzucchi, J. A. Spertus, Y. Wang, F. A. Masoudi, E. P. Havranek, and H. M. Krumholz Elevated Admission Glucose and Mortality in Elderly Patients Hospitalized With Heart Failure Circulation, April 14, 2009; 119(14): 1899 - 1907. [Abstract] [Full Text] [PDF]

				A. Y. Poppe, S. R. Majumdar, T. Jeerakathil, W. Ghali, A. M. Buchan, M. D. Hill, and the Canadian Alteplase for Stroke Effectiveness St Admission Hyperglycemia Predicts a Worse Outcome in Stroke Patients Treated With Intravenous Thrombolysis Diabetes Care, April 1, 2009; 32(4): 617 - 622. [Abstract] [Full Text] [PDF]

				The NICE-SUGAR Study Investigators Intensive versus Conventional Glucose Control in Critically Ill Patients N. Engl. J. Med., March 26, 2009; 360(13): 1283 - 1297. [Abstract] [Full Text] [PDF]

				R. J. Comi, J. Jacoby, D. Basta, M. Wood, and J. Butterly Improving Glucose Management by Redesigning the Care of Diabetic Inpatients Using a Nurse Practitioner Service Clin. Diabetes, March 1, 2009; 27(2): 78 - 81. [Full Text] [PDF]

				G. E. Umpierrez, T. Hor, D. Smiley, A. Temponi, D. Umpierrez, M. Ceron, C. Munoz, C. Newton, L. Peng, and D. Baldwin Comparison of Inpatient Insulin Regimens with Detemir plus Aspart Versus Neutral Protamine Hagedorn plus Regular in Medical Patients with Type 2 Diabetes J. Clin. Endocrinol. Metab., February 1, 2009; 94(2): 564 - 569. [Abstract] [Full Text] [PDF]

				G. Tsagalis, T. Akrivos, M. Alevizaki, E. Manios, K. Stamatellopoulos, A. Laggouranis, and K. N. Vemmos Renal dysfunction in acute stroke: an independent predictor of long-term all combined vascular events and overall mortality Nephrol. Dial. Transplant., January 1, 2009; 24(1): 194 - 200. [Abstract] [Full Text] [PDF]

				D. J. Wexler, D. M. Nathan, R. W. Grant, S. Regan, A. L. Van Leuvan, and E. Cagliero Prevalence of Elevated Hemoglobin A1c among Patients Admitted to the Hospital without a Diagnosis of Diabetes J. Clin. Endocrinol. Metab., November 1, 2008; 93(11): 4238 - 4244. [Abstract] [Full Text] [PDF]

				L. A. Sposato, M. M. Esnaola, R. Zamora, M. C. Zurru, O. Fustinoni, G. Saposnik, on behalf of ReNACer Investigators, and the Argentinian Neurological Society Quality of Ischemic Stroke Care in Emerging Countries: The Argentinian National Stroke Registry (ReNACer) Stroke, November 1, 2008; 39(11): 3036 - 3041. [Abstract] [Full Text] [PDF]

				N. J. D'Hondt Continuous Intravenous Insulin: Ready for Prime Time Diabetes Spectr, October 1, 2008; 21(4): 255 - 261. [Abstract] [Full Text] [PDF]

				M. Yong and M. Kaste Dynamic of Hyperglycemia as a Predictor of Stroke Outcome in the ECASS-II Trial Stroke, October 1, 2008; 39(10): 2749 - 2755. [Abstract] [Full Text] [PDF]

				D. Sander, K. Sander, and H. Poppert Review: Stroke in type 2 diabetes The British Journal of Diabetes & Vascular Disease, September 1, 2008; 8(5): 222 - 229. [Abstract] [PDF]

				M. T. McCormick, K. W. Muir, C. S. Gray, and M. R. Walters Management of Hyperglycemia in Acute Stroke: How, When, and for Whom? Stroke, July 1, 2008; 39(7): 2177 - 2185. [Full Text] [PDF]

				J. W. Rossano, M. D. Taylor, E. O. Smith, C. D. Fraser Jr., E. D. McKenzie, J. F. Price, H. A. Dickerson, D. P. Nelson, and A. R. Mott Glycemic profile in infants who have undergone the arterial switch operation: Hyperglycemia is not associated with adverse events. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 739 - 745. [Abstract] [Full Text] [PDF]

				B. G. Fahy and D. B. Coursin Critical Glucose Control: The Devil Is in the Details Mayo Clin. Proc., April 1, 2008; 83(4): 394 - 397. [Full Text] [PDF]

				A. Desachy, A. C. Vuagnat, A. D. Ghazali, O. T. Baudin, O. H. Longuet, S. N. Calvat, and V. Gissot Accuracy of Bedside Glucometry in Critically Ill Patients: Influence of Clinical Characteristics and Perfusion Index Mayo Clin. Proc., April 1, 2008; 83(4): 400 - 405. [Abstract] [Full Text] [PDF]

				J. J. Pasternak, D. G. McGregor, D. R. Schroeder, W. L. Lanier, Q. Shi, B. J. Hindman, W. R. Clarke, J. C. Torner, J. B. Weeks, M. M. Todd, et al. Hyperglycemia in Patients Undergoing Cerebral Aneurysm Surgery: Its Association With Long-term Gross Neurologic and Neuropsychological Function Mayo Clin. Proc., April 1, 2008; 83(4): 406 - 417. [Abstract] [Full Text] [PDF]

				A. A. Wong, P. J. Schluter, R. D. Henderson, J. D. O'Sullivan, and S. J. Read Natural history of blood glucose within the first 48 hours after ischemic stroke Neurology, March 25, 2008; 70(13): 1036 - 1041. [Abstract] [Full Text] [PDF]

				U. Holzinger, M. Feldbacher, A. Bachlechner, R. Kitzberger, V. Fuhrmann, and C. Madl Improvement of Glucose Control in the Intensive Care Unit: An Interdisciplinary Collaboration Study Am. J. Crit. Care., March 1, 2008; 17(2): 150 - 156. [Abstract] [Full Text] [PDF]

				A. Bruno, T. A. Kent, B. M. Coull, R. R. Shankar, C. Saha, K. J. Becker, B. M. Kissela, and L. S. Williams Treatment of Hyperglycemia In Ischemic Stroke (THIS): A Randomized Pilot Trial Stroke, February 1, 2008; 39(2): 384 - 389. [Abstract] [Full Text] [PDF]

				J. S. Savino and A. T. Cheung Cardiac Anesthesia Card. Surg. Adult, January 1, 2008; 3(2008): 281 - 314. [Full Text]

				J. A. Ballweg, G. Wernovsky, R. F. Ittenbach, J. Bernbaum, M. Gerdes, P. R. Gallagher, T. E. Dominguez, E. Zackai, R. R. Clancy, S. C. Nicolson, et al. Hyperglycemia After Infant Cardiac Surgery Does Not Adversely Impact Neurodevelopmental Outcome Ann. Thorac. Surg., December 1, 2007; 84(6): 2052 - 2058. [Abstract] [Full Text] [PDF]

				T. S. Shine, M. Uchikado, C. C Crawford, and M. J Murray Importance of Perioperative Blood Glucose Management in Cardiac Surgical Patients Asian Cardiovasc Thorac Ann, December 1, 2007; 15(6): 534 - 538. [Abstract] [Full Text] [PDF]

				S. G. Oeyen, E. A. Hoste, C. D. Roosens, J. M. Decruyenaere, and S. I. Blot Adherence to and Efficacy and Safety of an Insulin Protocol in the Critically Ill: A Prospective Observational Study Am. J. Crit. Care., November 1, 2007; 16(6): 599 - 608. [Abstract] [Full Text] [PDF]

				F. Puskas, H. P. Grocott, W. D. White, J. P. Mathew, M. F. Newman, and S. Bar-Yosef Intraoperative Hyperglycemia and Cognitive Decline After CABG Ann. Thorac. Surg., November 1, 2007; 84(5): 1467 - 1473. [Abstract] [Full Text] [PDF]

				K. Asadollahi, N. Beeching, and G. Gill Hyperglycaemia and mortality J R Soc Med, November 1, 2007; 100(11): 503 - 507. [Abstract] [Full Text] [PDF]

				H. B. van der Worp and J. van Gijn Acute Ischemic Stroke N. Engl. J. Med., August 9, 2007; 357(6): 572 - 579. [Full Text] [PDF]

				M. Anthony Treatment of Hypoglycemia in Hospitalized Adults: A Descriptive Study The Diabetes Educator, July 1, 2007; 33(4): 709 - 715. [Abstract] [Full Text] [PDF]

				I. Vanhorebeek, L. Langouche, and G. Van den Berghe Tight Blood Glucose Control With Insulin in the ICU: Facts and Controversies Chest, July 1, 2007; 132(1): 268 - 278. [Abstract] [Full Text] [PDF]

				M. Uyttenboogaart, M. W. Koch, R. E. Stewart, P. C. Vroomen, G.-J. Luijckx, and J. De Keyser Moderate hyperglycaemia is associated with favourable outcome in acute lacunar stroke Brain, June 1, 2007; 130(6): 1626 - 1630. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. V. d. Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J. Suppl., June 1, 2007; 9(suppl_C): C3 - C74. [Full Text] [PDF]

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]

				L. R. Schmeltz, A. J. DeSantis, V. Thiyagarajan, K. Schmidt, E. O'Shea-Mahler, D. Johnson, J. Henske, P. M. McCarthy, T. G. Gleason, E. C. McGee, et al. Reduction of Surgical Mortality and Morbidity in Diabetic Patients Undergoing Cardiac Surgery With a Combined Intravenous and Subcutaneous Insulin Glucose Management Strategy Diabetes Care, April 1, 2007; 30(4): 823 - 828. [Abstract] [Full Text] [PDF]

				M. Wilson, J. Weinreb, and G. W. S. Hoo Intensive Insulin Therapy in Critical Care: A review of 12 protocols Diabetes Care, April 1, 2007; 30(4): 1005 - 1011. [Abstract] [Full Text] [PDF]

				H. Kamada, F. Yu, C. Nito, and P. H. Chan Influence of Hyperglycemia on Oxidative Stress and Matrix Metalloproteinase-9 Activation After Focal Cerebral Ischemia/Reperfusion in Rats: Relation to Blood-Brain Barrier Dysfunction Stroke, March 1, 2007; 38(3): 1044 - 1049. [Abstract] [Full Text] [PDF]

				F. C. Moreton, M. McCormick, and K. W Muir Insular Cortex Hypoperfusion and Acute Phase Blood Glucose After Stroke: A CT Perfusion Study Stroke, February 1, 2007; 38(2): 407 - 410. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. Van den Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J., January 1, 2007; 28(1): 88 - 136. [Full Text] [PDF]

				J. Dawson and M. Walters New and emerging treatments for stroke Br. Med. Bull., November 7, 2006; (2006) ldl011v1. [Abstract] [Full Text] [PDF]

				S. E. Inzucchi Management of Hyperglycemia in the Hospital Setting N. Engl. J. Med., November 2, 2006; 355(18): 1903 - 1911. [Full Text] [PDF]

				S. P. Hays, E. O. Smith, and A. L. Sunehag Hyperglycemia Is a Risk Factor for Early Death and Morbidity in Extremely Low Birth-Weight Infants Pediatrics, November 1, 2006; 118(5): 1811 - 1818. [Abstract] [Full Text] [PDF]

				C. De Block, B. Manuel-y-Keenoy, L. Van Gaal, and P. Rogiers Intensive Insulin Therapy in the Intensive Care Unit: Assessment by continuous glucose monitoring Diabetes Care, August 1, 2006; 29(8): 1750 - 1756. [Abstract] [Full Text] [PDF]

				L. Allport, T. Baird, K. Butcher, L. MacGregor, J. Prosser, P. Colman, and S. Davis Frequency and Temporal Profile of Poststroke Hyperglycemia Using Continuous Glucose Monitoring Diabetes Care, August 1, 2006; 29(8): 1839 - 1844. [Abstract] [Full Text] [PDF]

				The ACE/ADA Task Force on Inpatient Diabetes American College of Endocrinology and American Diabetes Association Consensus Statement on Inpatient Diabetes and Glycemic Control: A call to action Diabetes Care, August 1, 2006; 29(8): 1955 - 1962. [Full Text] [PDF]

				A. Martin, S. Rojas, A. Chamorro, C. Falcon, N. Bargallo, and A. M. Planas Why Does Acute Hyperglycemia Worsen the Outcome of Transient Focal Cerebral Ischemia?: Role of Corticosteroids, Inflammation, and Protein O-Glycosylation Stroke, May 1, 2006; 37(5): 1288 - 1295. [Abstract] [Full Text] [PDF]

				K. Matz, K. Keresztes, C. Tatschl, M. Nowotny, A. Dachenhausen, M. Brainin, and J. Tuomilehto Disorders of Glucose Metabolism in Acute Stroke Patients: An underrecognized problem Diabetes Care, April 1, 2006; 29(4): 792 - 797. [Abstract] [Full Text] [PDF]

				S J Finney and T W Evans Tight glycaemic control in acute exacerbations of COPD. Thorax, April 1, 2006; 61(4): 275 - 279. [Full Text] [PDF]

				E H Baker, C H Janaway, B J Philips, A L Brennan, D L Baines, D M Wood, and P W Jones Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease Thorax, April 1, 2006; 61(4): 284 - 289. [Abstract] [Full Text] [PDF]

				J. A. Hayden, P. Cote, and C. Bombardier Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med, March 21, 2006; 144(6): 427 - 437. [Abstract] [Full Text] [PDF]

				J. S. Krinsley and R. L. Jones Cost Analysis of Intensive Glycemic Control in Critically Ill Adult Patients Chest, March 1, 2006; 129(3): 644 - 650. [Abstract] [Full Text] [PDF]

				L. Langouche, I. Vanhorebeek, and G. Van den Berghe Glycaemic control in trauma patients, is there a role? Trauma, January 1, 2006; 8(1): 13 - 19. [Abstract] [PDF]

				American Diabetes Association Standards of Medical Care in Diabetes-2006 Diabetes Care, January 1, 2006; 29(suppl_1): S4 - S42. [Full Text] [PDF]

				R. Garg, A. Chaudhuri, F. Munschauer, and P. Dandona Hyperglycemia, Insulin, and Acute Ischemic Stroke: A Mechanistic Justification for a Trial of Insulin Infusion Therapy Stroke, January 1, 2006; 37(1): 267 - 273. [Abstract] [Full Text] [PDF]

				J. A. Frontera, A. Fernandez, J. Claassen, M. Schmidt, H. C. Schumacher, K. Wartenberg, R. Temes, A. Parra, N. D. Ostapkovich, and S. A. Mayer Hyperglycemia After SAH: Predictors, Associated Complications, and Impact on Outcome Stroke, January 1, 2006; 37(1): 199 - 203. [Abstract] [Full Text] [PDF]

				Part 9: Adult Stroke Circulation, December 13, 2005; 112(24_suppl): IV-111 - IV-120. [Full Text] [PDF]

				F. Vancheri, M. Curcio, A. Burgio, S. Salvaggio, G. Gruttadauria, M.C. Lunetta, R. Dovico, and M. Alletto Impaired glucose metabolism in patients with acute stroke and no previous diagnosis of diabetes mellitus QJM, December 1, 2005; 98(12): 871 - 878. [Abstract] [Full Text] [PDF]

				J D Newton, H M Blackledge, and I B Squire Ethnicity and variation in prognosis for patients newly hospitalised for heart failure: a matched historical cohort study Heart, December 1, 2005; 91(12): 1545 - 1550. [Abstract] [Full Text] [PDF]

				Part 4: Advanced Life Support Circulation, November 29, 2005; 112(22_suppl): III-25 - III-54. [Full Text] [PDF]

				Part 9: Stroke Circulation, November 29, 2005; 112(22_suppl): III-110 - III-104. [Full Text] [PDF]

				D P Breen, M J G Dunn, R J Davenport, and A J Gray Epidemiology, clinical characteristics, and management of adults referred to a teaching hospital first seizure clinic Postgrad. Med. J., November 1, 2005; 81(961): 715 - 718. [Abstract] [Full Text] [PDF]

				C. L. Martin Case Study: Whose Diabetes Is It Anyway? Diabetes Self-Management After a Stroke Diabetes Spectr, October 1, 2005; 18(4): 196 - 198. [Full Text] [PDF]

				N. W. Cheung, B. Napier, C. Zaccaria, and J. P. Fletcher Hyperglycemia Is Associated With Adverse Outcomes in Patients Receiving Total Parenteral Nutrition Diabetes Care, October 1, 2005; 28(10): 2367 - 2371. [Abstract] [Full Text] [PDF]

				R. Lattermann, G. Belohlavek, S. Wittmann, B. Fuchtmeier, and M. Gruber The Anticatabolic Effect of Neuraxial Blockade After Hip Surgery Anesth. Analg., October 1, 2005; 101(4): 1202 - 1208. [Abstract] [Full Text] [PDF]

				B. Collier, J. Diaz Jr, R. Forbes, J. Morris Jr, A. May, J. Guy, A. Ozdas, W. Dupont, R. Miller, and G. Jensen The Impact of a Normoglycemic Management Protocol on Clinical Outcomes in the Trauma Intensive Care Unit JPEN J Parenter Enteral Nutr, September 1, 2005; 29(5): 353 - 359. [Abstract] [Full Text] [PDF]

				R.E. Anderson, K. Klerdal, T. Ivert, N. Hammar, G. Barr, and A. Owall Are even impaired fasting blood glucose levels preoperatively associated with increased mortality after CABG surgery? Eur. Heart J., August 1, 2005; 26(15): 1513 - 1518. [Abstract] [Full Text] [PDF]

				M. Ribo, C. Molina, J. Montaner, M. Rubiera, R. Delgado-Mederos, J. F. Arenillas, M. Quintana, and J. Alvarez-Sabin Acute Hyperglycemia State Is Associated With Lower tPA-Induced Recanalization Rates in Stroke Patients Stroke, August 1, 2005; 36(8): 1705 - 1709. [Abstract] [Full Text] [PDF]

				G. Van den Berghe, K. Schoonheydt, P. Becx, F. Bruyninckx, and P. J. Wouters Insulin therapy protects the central and peripheral nervous system of intensive care patients Neurology, April 26, 2005; 64(8): 1348 - 1353. [Abstract] [Full Text] [PDF]

				F. A. McAlister, S. R. Majumdar, S. Blitz, B. H. Rowe, J. Romney, and T. J. Marrie The Relation Between Hyperglycemia and Outcomes in 2,471 Patients Admitted to the Hospital With Community-Acquired Pneumonia Diabetes Care, April 1, 2005; 28(4): 810 - 815. [Abstract] [Full Text] [PDF]

				S. E. Inzucchi and J. Rosenstock Counterpoint: Inpatient Glucose Management: A premature call to arms? Diabetes Care, April 1, 2005; 28(4): 976 - 979. [Full Text] [PDF]

				R Fogelholm, K Murros, A Rissanen, and S Avikainen Admission blood glucose and short term survival in primary intracerebral haemorrhage: a population based study J. Neurol. Neurosurg. Psychiatry, March 1, 2005; 76(3): 349 - 353. [Abstract] [Full Text] [PDF]

				T. M Conner, K. R Flesner-Gurley, and J. C Barner Hyperglycemia in the Hospital Setting: The Case for Improved Control Among Non-Diabetics Ann. Pharmacother., March 1, 2005; 39(3): 492 - 501. [Abstract] [Full Text] [PDF]

				W. N. Kernan, C. M. Viscoli, S. E. Inzucchi, L. M. Brass, D. M. Bravata, G. I. Shulman, and J. C. McVeety Prevalence of Abnormal Glucose Tolerance Following a Transient Ischemic Attack or Ischemic Stroke Arch Intern Med, January 24, 2005; 165(2): 227 - 233. [Abstract] [Full Text] [PDF]

				American Diabetes Association Standards of Medical Care in Diabetes Diabetes Care, January 1, 2005; 28(suppl_1): S4 - S36. [Full Text] [PDF]

				R. O. Roine and P. J. Lindsberg Editorial Comment--Prime Time for Proactive Blood Glucose Control? Stroke, November 1, 2004; 35(11): 2498 - 2499. [Full Text] [PDF]

				J. Alvarez-Sabin, C. A. Molina, M. Ribo, J. F. Arenillas, J. Montaner, R. Huertas, E. Santamarina, and M. Rubiera Impact of Admission Hyperglycemia on Stroke Outcome After Thrombolysis: Risk Stratification in Relation to Time to Reperfusion Stroke, November 1, 2004; 35(11): 2493 - 2498. [Abstract] [Full Text] [PDF]

				A. G. Pittas, R. D. Siegel, and J. Lau Insulin Therapy for Critically Ill Hospitalized Patients: A Meta-analysis of Randomized Controlled Trials Arch Intern Med, October 11, 2004; 164(18): 2005 - 2011. [Abstract] [Full Text] [PDF]

				Z. T. Bloomgarden Inpatient Diabetes Control: Rationale Diabetes Care, August 1, 2004; 27(8): 2074 - 2080. [Full Text] [PDF]

				J. S. Krinsley Effect of an Intensive Glucose Management Protocol on the Mortality of Critically Ill Adult Patients Mayo Clin. Proc., August 1, 2004; 79(8): 992 - 1000. [Abstract] [PDF]

				R. Leigh, O. O. Zaidat, M. F. Suri, G. Lynch, S. Sundararajan, J. L. Sunshine, R. Tarr, W. Selman, D. M.D. Landis, and J. I. Suarez Predictors of Hyperacute Clinical Worsening in Ischemic Stroke Patients Receiving Thrombolytic Therapy Stroke, August 1, 2004; 35(8): 1903 - 1907. [Abstract] [Full Text] [PDF]

				L. E. Allport, K. S. Butcher, T. A. Baird, L. MacGregor, P. M. Desmond, B. M. Tress, P. Colman, and S. M. Davis Insular Cortical Ischemia Is Independently Associated With Acute Stress Hyperglycemia Stroke, August 1, 2004; 35(8): 1886 - 1891. [Abstract] [Full Text] [PDF]

				A. Kouroedov, M. Eto, H. Joch, M. Volpe, T. F. Luscher, and F. Cosentino Selective Inhibition of Protein Kinase C{beta}2 Prevents Acute Effects of High Glucose on Vascular Cell Adhesion Molecule-1 Expression in Human Endothelial Cells Circulation, July 6, 2004; 110(1): 91 - 96. [Abstract] [Full Text] [PDF]

				E. S. Nylen and B. Muller Endocrine Changes in Critical Illness J Intensive Care Med, March 1, 2004; 19(2): 67 - 82. [Abstract] [PDF]

				S. K. Andersen, J. Gjedsted, C. Christiansen, and E. Tonnesen The roles of insulin and hyperglycemia in sepsis pathogenesis J. Leukoc. Biol., March 1, 2004; 75(3): 413 - 421. [Abstract] [Full Text] [PDF]

				S. Clement, S. S. Braithwaite, M. F. Magee, A. Ahmann, E. P. Smith, R. G. Schafer, and I. B. Hirsch Management of Diabetes and Hyperglycemia in Hospitals Diabetes Care, February 1, 2004; 27(2): 553 - 591. [Full Text] [PDF]

				P. J. Lindsberg and R. O. Roine Hyperglycemia in Acute Stroke Stroke, February 1, 2004; 35(2): 363 - 364. [Full Text] [PDF]

				S. Passero, G. Ciacci, and M. Ulivelli The influence of diabetes and hyperglycemia on clinical course after intracerebral hemorrhage Neurology, November 25, 2003; 61(10): 1351 - 1356. [Abstract] [Full Text] [PDF]

				S. M. Dorhout Mees, G. W. van Dijk, A. Algra, D. R.J. Kempink, and G. J.E. Rinkel Glucose levels and outcome after subarachnoid hemorrhage Neurology, October 28, 2003; 61(8): 1132 - 1133. [Abstract] [Full Text] [PDF]

				T. A. Baird, M. W. Parsons, T. Phanh, K. S. Butcher, P. M. Desmond, B. M. Tress, P. G. Colman, B. R. Chambers, and S. M. Davis Persistent Poststroke Hyperglycemia Is Independently Associated With Infarct Expansion and Worse Clinical Outcome Stroke, September 1, 2003; 34(9): 2208 - 2214. [Abstract] [Full Text] [PDF]

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Capes, S. E. Articles by Gerstein, H. C. Search for Related Content PubMed PubMed Citation Articles by Capes, S. E. Articles by Gerstein, H. C. Related Collections Type 1 diabetes Type 2 diabetes Glucose intolerance Acute Cerebral Hemorrhage Acute Cerebral Infarction Other Stroke Treatment - Medical