Desilles JP, Meseguer E, Labreuche J, Lapergue B, Sirimarco G, Gonzalez-Valcarcel J. Diabetes Mellitus, Admission Glucose, and Outcomes After StrokeThrombolysis: A Registry and Systematic Review. Stroke. 2013
The association between diabetes or post-stroke hyperglycemia and poor clinical outcomes after thrombolysis has not been clearly defined. Desilles et al. present data derived from their local prospective registry and a metaanalysis evaluating this relevant issue.
The systematic review indicated that a history of diabetes and higher admission glucose level predicted worse functional outcomes and increased rates of symptomatic intracerebral hemorrhages. Interestingly, the data from their registry revealed that diabetes and initial glycemia did not influence endovascular recanalization rates.
The authors discuss the potential inhibitory effect of hyperglycemia in the fibrinolytic system and the deleterious consequences of high glucose levels on the blood-brain barrier. However, they acknowledge that stress-hyperglycemia induced by the stroke may simply constitute a marker of a more severe disease given its reported correlation with higher NIH stroke scale and larger infarct core volumes. This would hypothetically explain why intensive glycemic control was not found to lead to improved outcomes in hyperacute ischemic strokes, and makes us wonder about the causal relationship between hyperglycemia and poor prognosis.