The glycemia in acute stroke study.

Stroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. They should not exceed 750 words (including references) and may be subject to editing or abridgment. Please submit letters in duplicate, typed double-spaced. Include a fax number for the corresponding author and a completed copyright transfer agreement form (available online at To the Editor: We read with interest the recent publication by Fuentes and colleagues concerning the prognostic value of capillary blood glucose levels in determining prognosis after acute stroke. 1 Admission hyperglycemia is a common finding after acute stroke, and studies by our own and other groups have confirmed its association with poor clinical outcomes. 2,3 The Glycemia in Acute Stroke (GLIAS) study reported by Fuentes et al was an observational study in which 476 patients presenting with acute ischemic stroke had capillary blood glucose measurements taken on admission and then 3 times daily during the first 48 hours in hospital. Maximum capillary blood glucose Ͼ155 mg/dL (8.6 mmol/L) at any time during the first 2 days was shown to have predictive value for poor outcome at 3 months. However, hyperglycemia or indeed maximum blood glucose during this time period may have been influenced by several factors including administration of intravenous fluids, reinstitution of oral feeding or initiation of enteral feeding, all of which may be associated with stroke severity and thereby outcome. The issue of feeding is of particular relevance because all patients in the GLIAS study received oral or tube nutrition (where required) at 24 hours after admission and the timing of capillary blood glucose measurements in relation to mealtimes or feeds is not specified. Furthermore, glucose-lowering therapy was not standardized , being left to the discretion of the supervising clinician, and this could also have influenced the maximum glucose level seen in individual patients. Moreover, some patients likely to have a poor prognosis due to stroke severity or premorbid disability were also excluded from the study. The GLIAS study does not provide any information on the previous glycemic status of included patients, such as admission glycohemoglobin (HbA1c) levels. Our group has shown that patients with known and therefore treated type 2 diabetes mellitus may have a better clinical outcome after ischemic stroke than individuals with previously unrecognized diabetes or impaired glucose tolerance in whom the diagnosis is made on admission to hospital. 4 We would also question the interpretation of the …