Dynamics of Hyperglycaemia after Acute Stroke – Implications for practice and future research from a systematic review of descriptive cohort studies

Introduction:Post stroke hyperglycaemia may represent a stress response, an inflammatory response or a diabetes mellitus syndrome. This review informs on the dynamics of hyperglycaemia in this population and implications for practice and future research.Method:A search was conducted in MEDLINE and PubMed electronic databases for descriptive cohort studies published between January 1996 and March 2011, where the prime focus was the dynamic of hyperglycaemia over consecutive days, among adults admitted to hospital with acute stroke. Quality assessment was undertaken using the STROBE Statement Group checklist for descriptive cohort studies.Results:Seventeen cohort studies meeting specified eligibility criteria, were identified. Findings indicate that the prevalence of hyperglycaemia is high on hospital admission, and is likely to increase further over successive days affecting both patients with and without diagnosed diabetes mellitus. Delayed patterns of hyperglycaemia may not be evident till day 3 and even till day 7 after stroke. Although hyperglycaemia rates reduce slightly between hospital discharge and 3 month follow-up, when patients with no pre-admission history of diabetes are screened at follow-up, it is likely that over half will meet the criteria for diabetes mellitus or a pre-diabetes syndrome. Conclusion: In planning future cohort studies it is recommended to that common thresholds for hyperglycaemia criteria are applied, and consistent and reliable clinical outcome measurements and outcome end-points are used to aid future meta-analysis. There is substantive evidence to support the need to monitor glycaemia and screen patients admitted to hospital with stroke for undiagnosed diabetes mellitus and pre-diabetes syndromes.