July 12, 2002 INDIANAPOLIS -- Stroke patients who have hyperglycemia (high blood sugar) at the time of admission to the hospital for treatment of the stroke are at higher risk of death than stroke patients with normal blood sugar levels, according to a study published in the July 9 issue of the journal Neurology by researchers from the Indiana University School of Medicine, the Richard L. Roudebush Veterans Administration Medical Center and the Regenstrief Institute for Health Care.
The researchers led by the study's principal investigator, Linda S. Williams, M.D., assistant professor of neurology at the IU School of Medicine, analyzed the electronic medical records of 656 stroke patients hospitalized over a five-year period. Over 40 percent of these stroke patents had high blood sugar levels. Although most had previous diagnoses of diabetes, they did not have their blood sugar levels under control.
Dr. Williams and her colleagues found that having high blood sugar when the stroke occurred put patients at risk for higher 30-day, 1-year and 5-year mortality than if blood sugar levels were in the normal range. Patients with high blood sugar also stayed longer in the hospital and had higher hospital costs than those with normal blood sugar.
The researchers also reported that during hospitalization, the patients' hyperglycemia usually was not adequately addressed, with more than 90% of the hyperglycemic patients continuing to have high blood sugar during their hospital stay. They noted that although many treatments are available to lower blood sugar, improvements are needed in the implementation of these treatments during hospitalization.
"Diabetes is a growing problem in the United States. With the link shown in our study between diabetes and poor outcome after stroke, hyperglycemia at the time of stroke may become an even greater problem in years ahead both in terms of deaths and medical costs," says Dr. Williams.
Data used in the study was obtained from the Regenstrief Medical Records System, a physician-designed integrated inpatient and outpatient information system that is the largest coded, continuously operated electronic medical records system in the country.
"In the past, strokes and their devastating outcomes were considered almost 'acts of God,' a 'stroke' out of the blue. Now we know that they can be prevented, and once they occur, their consequences can be minimized through the use of thrombolytic 'clot-busting' drugs. This new study shows that other metabolic abnormalities such as hyperglycemia may also have substantial effects on outcomes of strokes. I hope this important yet preliminary study will lead to a controlled trial of tight blood glucose control among stroke patients with diabetes," notes William Tierney, M.D., senior author of the study.
The National Institutes of Health recently funded this group of IU School of Medicine neurologists and endocrinologists to conduct a phase II study of rapid normalization of high blood sugar at the time of stroke. "This treatment is potentially very appealing," says Dr. Williams, "because it is available at any hospital and is familiar to all physicians, so it could be widely used without major changes in the current health care system."
The current study was supported by funding from the Indiana University Diabetes Research and Training Center.
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