Risk of Hyperglycemia and Hypoglycemia in Patients With Acute Ischemic Stroke Based on Continuous Glucose Monitoring

J Stroke Cerebrovasc Dis. 2019 Dec;28(12):104346. doi: 10.1016/j.jstrokecerebrovasdis.2019.104346. Epub 2019 Sep 21.


Background: In patients with acute ischemic stroke, current guidelines recommend maintaining blood glucose levels in a range of 140-180 mg/dL and closely monitoring to prevent hypoglycemia (<60 mg/dL). We aimed to assess glucose variability by continuous glucose monitoring (CGM) and to demonstrate the risk of acute ischemic stroke patients with glucose levels outside of the glucose management recommendations.

Methods: Patients with ischemic stroke admitted within 7 days after onset were prospectively enrolled, and their blood glucose levels were monitored every 15 minutes for 72-hour period using the FreeStyle Libre Pro. Multivariate logistic regression analyses were used to analyze potential predictors for hyperglycemic (>180 mg/dL) and hypoglycemic (<60 mg/dL) events.

Results: A total of 39 acute ischemic stroke patients (mean age 75.9 ± 11.5 years) were enrolled, and CGM was started from 58.6 ± 41.9 hours after stroke onset. CGM showed hypoglycemic events in 19 patients and hyperglycemic events in 21 patients, and the frequencies of hypo- and hyperglycemic events during CGM were 10.1 ± 15.7% and 11.9 ± 22.5%, respectively. Hypoglycemic events were mainly observed in the night-time in patients with normoglycemia at admission. Logistic regression analyses demonstrated significant associations between the blood glucose level at admission and hypo- and hyperglycemic events on CGM.

Conclusions: This study of CGM found that many stroke patients have blood glucose levels outside the recommended guideline range in the acute phase. Blood glucose level on admission may be used as a predictor for hypo- and hyperglycemic events after admission.

Keywords: Continuous glucose monitoring (CGM); acute stroke; hyperglycemia; hypoglycemia.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Blood Glucose / metabolism*
  • Brain Ischemia / blood*
  • Brain Ischemia / diagnosis
  • Brain Ischemia / therapy
  • Female
  • Humans
  • Hyperglycemia / blood*
  • Hyperglycemia / diagnosis
  • Hyperglycemia / therapy
  • Hypoglycemia / blood*
  • Hypoglycemia / diagnosis
  • Hypoglycemia / therapy
  • Male
  • Middle Aged
  • Monitoring, Physiologic* / instrumentation
  • Patient Admission
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Stroke / blood*
  • Stroke / diagnosis
  • Stroke / therapy
  • Time Factors


  • Biomarkers
  • Blood Glucose