An Evaluation of Hyperglycaemia Management in Stroke Care : Implications for Practice

Background: Diabetes mellitus is a major risk factor for cardiovascular disease and stroke. Up to one third of patients admitted to hospital with acute stroke have a history of diabetes mellitus. In addition, 58% of patients with no history of diabetes mellitus may meet the World Health Organisation criteria for diabetes mellitus or impaired glucose tolerance, if screened 12 weeks after stroke. Stroke clinical guidelines recommend that glycaemia is monitored and hyperglycaemia is treated. Methods: This was a retrospective medical records review of 112 patients consecutively admitted with acute stroke to the 3 district general hospitals in one Health and Social Care Trust in Northern Ireland between January 1 and April 15, 2008. Data were extracted between 1 November and 22 December 2009. The dynamic of glycaemia was explored. The extent to which glucose was monitored and clinicians intervened to treat glycaemic excursions was ascertained. Rates and methods of screening for undiagnosed diabetes mellitus were determined. Results: Forty one (36.6%) patients experienced glucose excursions ≥7.8mmol/l. in the first five days since hospital admission. Hyperglycaemia was a persisting trend, but was under monitored and under treated. Laboratory glucose results that indicated hyperglycaemia among patients with no history of diabetes failed to influence higher rates of glucose monitoring or screening tests for diabetes. Conclusion: Hyperglycaemia is commonly observed in the acute phase of stroke, but glycaemia is under monitored and under treated after stroke. Stroke clinicians could play a significant role in cardiovascular disease protection, by embracing enhanced monitoring and screening for undiagnosed diabetes mellitus and pre-diabetes syndromes, and the initiation of treatment and health protection plans.