Hyperglycaemia monitoring and management in stroke care: policy vs practice

AimTo evaluate the extent to which hyperglycaemia was monitored and managed among patients admitted to hospital with acute stroke and transient ischaemic attack.MethodsWe conducted a retrospective cohort study involving a review of the records of 112 patients consecutively admitted with acute stroke or TIA to all 3 district general hospitals in one Health and Social Care Trust in Northern Ireland from January 1st to April 15th, 2008. Glucose results for each of the first five days of hospital admission were ascertained. We compared interventions, clinical outcome and discharge planning between patients who experienced glucose ≥7.8mmol/l. in the first five days, and patients with lower glucose results. ResultsThe daily prevalence rate of hyperglycaemia >7.8mmol/L across the first five days ranged from 24% to 34%. A total of 41 (37%) patients experienced hyperglycaemia on at least one occasion during the first five days. A history of diabetes mellitus prompted near patient glucose testing, but among patients without diagnosed diabetes, glycaemia was under-monitored. Hyperglycaemia was a persisting trend, was under treated, and under reported to general practitioners. Elevated glucose results failed to influence higher rates of fasting plasma glucose tests and BMI assessment. ConclusionsThere is a need for greater vigilance in the detection of hyperglycaemia and undiagnosed diabetes mellitus among patients admitted to hospital with stroke or TIA.