Wellness

[cherry]

Gut microbiome may affect some anti-diabetes drugs Date: December 11, 2018 Source: Wake Forest Baptist Medical Center Summary: Why do orally-administered drugs for diabetes work for some people but not others? According to researchers, bacteria that make up the gut microbiome may be the culprit. Share:

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Why do orally-administered drugs for diabetes work for some people but not others?

According to researchers at Wake Forest School of Medicine, bacteria that make up the gut microbiome may be the culprit.

In a review of more than 100 current published studies in humans and rodents, the School of Medicine team examined how gut bacteria either enhanced or inhibited a drug's effectiveness. The review is published in the Dec.11 edition of the journal EBioMedicine.

"For example, certain drugs work fine when given intravenously and go directly to the circulation, but when they are taken orally and pass through the gut, they don't work," said Hariom Yadav, Ph.D., assistant professor of molecular medicine at the School of Medicine, a part of Wake Forest Baptist Medical Center.

"Conversely, metformin, a commonly used anti-diabetes drug, works best when given orally but does not work when given through an IV."

The review examined interactions between the most commonly prescribed anti-diabetic drugs with the microbiome. Before being absorbed into the bloodstream, many orally-administered drugs are processed by intestinal microbial enzymes. As a result, the gut microbiome influences the metabolism of the drugs, thereby affecting patients' responses, Yadav said.

Type-2 diabetes, a disease characterized by carbohydrate and fat metabolism abnormalities, has recently become a global pandemic. One main function of gut microbiota is to metabolize non-digestive carbohydrates and regulate a person's metabolism.

"Our review showed that the metabolic capacity of a patient's microbiome could influence the absorption and function of these drugs by making them pharmacologically active, inactive or even toxic," he said. "We believe that differences in an individual's microbiome help explain why drugs will show a 90 or 50 percent optimum efficacy, but never 100 percent."

The researchers concluded that modulation of the gut microbiome by drugs may represent a target to improve, modify or reverse the effectiveness of current medications for type-2 diabetes.

"This field is only a decade old, and the possibility of developing treatments derived from bacteria related to or involved in specific diseases is tantalizing," Yadav said.

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Story Source:

Materials provided by Wake Forest Baptist Medical Center. Note: Content may be edited for style and length.

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[cherry]

In July 2017, the Centers for Disease Control and Prevention reported that 30.3 million adults, or 9.4 percent of the U.S. population, have diabetes. "Another 84.1 million have prediabetes, a condition that if not treated often leads to Type 2 diabetes within five years," according to the agency.

These figures are alarming because diabetes is a progressive disease that takes a massive toll on patients, their families and the U.S. economy. A 2018 report from the American Diabetes Association found that "the total costs of diagnosed diabetes have risen to $327 billion in 2017 from $245 billion in 2012, when the cost was last examined." In addition, the report noted that more than 300 million work days are lost to the economy because of diabetes and a quarter of all health care dollars spent in 2017 went toward care of diabetic patients.

RELATED CONTENT

A Patient's Guide to Diabetes

Much of this cost is related to the progressive nature of the disease and the fact that often, it takes a whole team of doctors to appropriately manage the health of a diabetic patient with complications. "Diabetes progresses over time," says Dr. Kathleen Wyne, associate professor in endocrinology at The Ohio State University Wexner Medical Center. "We put them on a medication, but eventually at some point it's going to progress and we're going to have to add a second medicine and a third or eventually insulin. That's just what diabetes does."

So what is diabetes? "Diabetes is a group of diseases all characterized by elevated blood glucose levels," says Dr. Kathleen Dungan, an endocrinologist also at the Wexner. There are two primary types of diabetes – Type 1, also sometimes called juvenile diabetes because it tends to occur more often in younger people, is an autoimmune disorder in which "the body's immune system attacks the pancreas, the organ that makes insulin that helps the body use glucose, the primary fuel source required by the body. In Type 1 diabetes, there's absolutely no insulin or very little insulin. Those patients are dependent upon (injecting) insulin for their life," Dungan says.

Type 2 diabetes is a chronic disease that's related to obesity and typically starts as prediabetes, also known as insulin resistance. With Type 2 diabetes, the pancreas isn't producing enough insulin or the patient's organs aren't able to use the insulin properly, requiring bigger doses of insulin to have an effect. "Type 2 diabetes can often be treated with pills or other medications and sometimes with diet alone," Dungan says, and it typically occurs in older, overweight patients with a strong family history of diabetes.

[See: The Best Foods to Prevent and Manage Diabetes.]

Who Can Help Me With Diabetes?

While many cases of diabetes are diagnosed by the patient's primary care provider, "the diagnosis could come from a lot of places," Dungan says. Because diabetes affects virtually every system in the body, symptoms can show up in seemingly unrelated places, such as the eyes, which are harmed by high blood sugars. Therefore, an ophthalmologist or optometrist conducting a routine eye exam may spot evidence of diabetes before other symptoms have developed.

Once you've been diagnosed, your primary care provider will likely take the lead on managing your disease, but you may need to work with several other doctors as your diabetes advances, including:

• An endocrinologist
• A podiatrist
• A dietitian or nutritionist
• An ophthalmologist
• A nephrologist
• A cardiologist
• A neurologist
• A physiatrist or physical medicine and rehabilitation physician
• A mental health provider, pharmacist and other clinicians

Endocrinologist

While your diabetes journey likely will begin with a primary care provider, you may need to see an endocrinologist early on for a more precise diagnosis, or later as the disease progresses. "The vast majority of the time, the primary care provider handles the initial diagnosis and management," Dungan says. "There may be situations where the patient has an unclear type of diabetes or presents with some severe findings like diabetic ketoacidosis (dangerously low levels of insulin that cause the body to produce ketones, acidic bodies that can be life-threatening) that requires hospitalization. In those cases, the endocrinologist might be involved from the beginning."

Endocrinologists are specialist experts in hormones and glands. Subspecialists in this field may focus specifically on treating diabetes or even a particular type of diabetes, and their vast knowledge about the disease and how it changes over time can be critical to treating patients appropriately.

"Unfortunately, there are not enough endocrinologists to take care of all the patients with diabetes," Dungan says, noting that "typically patients are referred to endocrinologists when they are failing initial therapies from their primary care providers. The endocrinologist typically takes care of more complex patients or patients who have advanced technologies like insulin pumps and patients who have more complications like hypoglycemia (low blood sugars) or require hospitalizations or other end-organ problems," such as kidney or heart disease.

"Endocrinologists often get involved when there are one or more complications, particularly if the glucose levels, the blood sugar levels, aren't well controlled," Dungan says. Endocrinologists often work closely with a patient's primary care provider to help coordinate all the health maintenance activities needed in these situations.

Podiatrist

These feet specialists can help diabetics manage foot health, which is a common problem. Patients with poorly controlled blood sugar levels are more likely to develop a condition called diabetic neuropathy that disrupts how the nerves in the feet and lower legs communicate with the brain. This means you could step on a piece of glass and never feel it. If infection sets it, it is less likely to heal properly because of the high blood sugars, and in extreme cases, some diabetics need to have toes, feet or lower limbs amputated because of diabetic neuropathy. Regular visits to a podiatrist can help identify problems, such as sores or ulcers, early before a more serious infection sets in and prevent you from having to take such drastic measures.

Dietitian or Nutritionist

Controlling your diet is a major component of effectively managing diabetes, and for that reason, you may need to work with a dietitian or nutritionist to make sure you're getting the right balance of nutrients while tightly controlling your blood sugar levels.

Ophthalmologist

Eye care becomes critical for diabetic patients because over time, elevated blood sugar levels can damage the retina and other delicate structures in the eye. Dr. Stephanie Marioneaux, an ophthalmologist in private practice in Chesapeake, Virginia, and clinical spokesperson for the American Academy of Ophthalmology, says seeing an ophthalmologist is an important component of maintaining your vision. When you're first diagnosed with diabetes, you may be sent to an ophthalmologist for a baseline evaluation to look for holes or tears in the retina – a thin film of light-sensitive cells at the back of the eyeball – that could be a sign of diabetic retinopathy or other complications of diabetes, Marioneaux says. Detached retinas are another common complication of diabetes that an ophthalmologist can perform surgery to correct.

In addition, "ophthalmologists are among the earliest people to diagnose diabetes in patients," Marioneaux says. Because they are trained to look for tell-tale signs of a problem, an annual visit to the eye doctor could result in a suspicion of diabetes that will be further investigated by your primary care provider or an endocrinologist.

[See: 10 Myths About Diabetes.]

Nephrologist

Nephrologists care for the kidneys, two bean-shaped organs in the mid-back that remove toxins from the blood. Diabetes is a major risk factor for developing kidney disease. Dr. Maria Bermudez, a nephrologist at Geisinger in Danville, Pennsylvania recommends that "kidney function be checked regularly," as part of routine lab work conducted in diabetics because the kidneys are sensitive to fluctuations in blood sugar levels and likely to suffer negative consequences from diabetes as the disease progresses. If evidence of kidney disease is found, you may be referred to a nephrologist for further testing and treatment.

Cardiologist

Because they share so many risk factors, heart disease and diabetes often go hand-in-hand, and as a result, many diabetics end up seeing a cardiologist, or heart specialist, at some point during the course of their treatment. A cardiologist can help counsel you on how to keep your heart as healthy as possible despite a diabetes diagnosis.

Neurologist

Dungan says people with diabetes are much more likely to suffer strokes, and if such occurs, you'll likely need to work with a neurologist to address the issue and prevent future strokes. Neurologists are experts in nerves, and some may focus on the brain while others may center their practices on other aspects of the nervous system. They can also help diabetics manage nerve damage in the extremities, also called peripheral neuropathy. According to the National Institute of Diabetes and Digestive and Kidney Diseases "research suggests that up to one-half of people with diabetes have peripheral neuropathy." The NIDDK also notes that about 30 percent of diabetics have autonomic neuropathy, a type of nerve damage that affects the internal organs. A neurologist can help you manage these issues.

Physiatrist or Physical Medicine and Rehabilitation Physician

Physiatrists, also called physical medicine and rehabilitation physicians, can help diabetics who need rehabilitative care get back to better health. This may become particularly important if the diabetic has had a stroke and needs to regain the capacity to walk or speak. It may also be an important aspect of post-surgical recovery, such as after an amputation necessitated by diabetic neuropathy. You may also work with a physical or occupational therapist to regain full function after a trauma such as surgery or a stroke.

Mental Health Professionals, Pharmacists and Other Clinicians

In addition to the above-named doctors, you may come into contact with many other health care providers over the course of your care. Pharmacists fill the prescriptions you need and alert the team to potentially dangerous drug interactions. A social worker, psychologist or psychiatrist can help you manage the emotional side of dealing with a chronic illness. You may also come in contact with a host of physician assistants and nurse practitioners along the way who all contribute their expertise towards keeping you healthy.

Managing Care

That's a lot of specialists and subspecialists you may end up dealing with at some point during your diabetes journey, and they'll all need to communicate with each other about your progress. Electronic health records can help keep everyone apprised of a patient's progress, but even so, in most cases, your primary care provider or family doctor will be tasked with coordinating your care and communicating with the team to make sure you're on target to meet your treatment goals.

Dungan says that though an endocrinologist is often involved in helping manage a diabetic's care, "the primary care provider remains an integral part of the team, ensuring that all of the health maintenance and screening tests are completed." This provider acts "as a central coordination hub" that helps all the other specialists provide high-quality, comprehensive intervention.

Preventing Complications

As with anything, preventing a problem before it starts leads to better outcomes. Dungan says tight control of blood sugars can prevent complications and keep you healthier longer, despite the progressive nature of the disease. "There are a number of screening and preventive measures to help prevent these complications, so that's going to be job number one – to try to identify them early and/or prevent them from occurring in the first place." Your primary care provider will likely take the lead on these preventive and screening activities, but other specialists may be involved too, such as in the case of an annual eye exam by an ophthalmologist, regular foot checks by a podiatrist and regular blood work, urinalysis and other lab tests to look for kidney disease and other problems that can occur with the internal organs. Talk with your primary care provider to make sure that all of the ongoing health maintenance tests you need are being completed on schedule.

[Teddie]

I appreciate you taking the time to share these, @cherry.  Diabetes is a progressive disease and affects every part of our body. Ugh, how depressing to know it’s probably going to get worse before it gets better. 

[cherry]

@Teddie  you know, sometimes  it seems, we are fighting a giant, but, we still need to do the best we can ,to stay healthy

They are finding new  information everyday, and the entire world is working on a solution. The glass is really half full. Don't lose heart

[Teddie]

If you ask anyone in my family, I was always the one who leaned toward the healthy lifestyle and took certain vitamins. I’ve just improved on that as I’ve learned more. But I’m the one who has diabetes, no one else in my family does. It’s just discouraging to know as I get older things can start to get worse. 

Thank you, dear @cherry, for your kind, encouraging words. We will hang in there. 

[cherry]

“I didn’t listen to any of the pre-diabetes signs,” Randy Jackson said. (Randy Jackson)

Randy Jackson says he shouldn’t have been surprised when he was diagnosed with Type-2 diabetes years ago. All the signs were there: His body often felt hot; he was lethargic; he couldn’t quite quench his thirst.

“I didn’t listen to any of the pre-diabetes signs,” he said. “You’d think that with all the knowledge out there you would heed those warnings. It runs in my family and I should have been more careful.”

Instead, Jackson’s first inkling that something was awry came from a visit to his dentist, who told Jackson that, based on the health of his gums, he might have high blood sugar. A month later, Jackson ended up in a hospital emergency room, and was diagnosed with Type-2 diabetes.

That was 18 years ago. Shortly afterward, the music producer and then-“American Idol” judge began working with a behavior modification therapist to help him understand why he ate the way he did. He underwent gastric bypass surgery and lost 120 pounds. He has kept the diabetes in check with a mix of medication, healthful eating and regular exercise. Nor has Jackson forgotten that visit to his dentist; he’s partnered with Colgate Total and the American Diabetes Assn. on a campaign to spotlight the connection between gum disease and diabetes, a condition which is diagnosed on average once every 21 seconds in the U.S.

Here, he shares his six tips for keeping off the weight and staying healthy — and why he models his meals after airline food.

1. You don’t have to hit the gym

I don’t go to the gym. I hate the idea of a trainer barking at me. Let me do my own thing. I love tennis. I started walking more every day. I like yoga and Pilates. Pilates is the best exercise ever invented because it strengthens your whole core.

2. Embrace drastic changes

My diet before diabetes was horrific. It was basically anything I wanted. If someone threw a doughnut party I’d have 14 doughnuts. Landing in the ER was a huge rude awakening but it had a silver lining because it forced me to get my life together. You have a choice — do you want to feel good or do you want to feel bad?

3. Do a deep dive into “why?”

Behavior modification therapy really helped me. I’m one of those addictive personalities that has to completely change the way I look at something to have it sit well in my life. I began to look at food as the nourishment I needed, not as a party.

4. Learn from airplane food

I’ve been vegan and vegetarian and tried all sorts of diets. To me, the airplane meal is the perfect meal because of the portion. You have a piece of meat the size of your palm. Everything is portioned out, and it’s a little bit of everything. You shouldn’t be eating more than that.

5. Aim for balanced meals

For breakfast, I try to get in some protein — maybe eggs with bacon. Lunch is salad and fish. I snack throughout the day on Vega protein bars and crisps, which are all plant-based.

6. Before you eat, stop and think

Ask yourself, “Why am I eating this bucket of ice cream?” We eat our feelings. We eat because we are anxious or disappointed or emotional. I had to learn to deal with feelings without using food.

[cherry]

UM study testing whether Omega 3 and vitamin D can halt progression of Type 1 diabetes

By Julie Landry Laviolette Special to the Miami Herald

November 21, 2018 01:04 PM,

Updated November 21, 2018 01:04 PM

Dr. Camillo Ricordi, of the University of Miami Miller School of Medicine, is working on islet cell transplantation. Diabetes patients who have had the cell transplants are now living without insulin. Ricordi is director of the Diabetes Research Institute, which is currently seeking Type 1 diabetes patients for a clinical trial to test if high doses of omega-3 and vitamin D can halt progression of the disease. Al Diaz Miami Herald file

Adult and pediatric Type 1 diabetes patients are being sought for a clinical trial to test if high doses of omega-3 and vitamin D can halt the progression of the disease.

The Diabetes Research Institute at the University of Miami Miller School of Medicine is conducting the trial.

The Poseidon Trial will study the safety and effectiveness of the two oral medications, with the hope that it may slow or stop the progression of the autoimmune process and preserve insulin-producing cells, essentially halting Type 1 diabetes from developing further.

In type 1 diabetes, the body does not produce insulin, which the body needs to get glucose from the bloodstream into the cells.

Scientific reports have suggested that high-dose omega-3 and vitamin D supplementation may improve autoimmune conditions like Type 1 diabetes.

“What has been found is that omega-3 and vitamin D, above a certain dose, become both anti-inflammatory and immunomodulatory,” meaning that they can change and regulate the body’s immune system, said Dr. Camillo Ricordi, director of the Diabetes Research Institute at the University of Miami.

Inflammation may be one of the triggers for autoimmunity that leads to the onset of the disease. It also may also affect insulin resistance, Ricordi said in a statement announcing the trial.

Results from a recent case study examining the role of omega-3 and vitamin D in preserving beta cell function (to store and release insulin) in three pediatric patients with Type 1 diabetes warranted further investigation of the therapeutic strategy, he said.

“The combination of the two are safe and very inexpensive compared to other expensive biologic drugs that are being tested, so I think it is a safe, affordable alternative that can have a profound impact on not just Type 1 diabetes, but autoimmune conditions in general,” Ricordi said.

At center, Dr. Camillo Ricordi from University of Miami’s medical school is working on islet cell transplantation. Diabetes patients who have had the cell transplants are now living without insulin.

Al Diaz Miami Herald file

The Diabetes Research Institute is enrolling 56 adults and children ages 6 to 65 with Type 1 diabetes, both newly diagnosed and those who were diagnosed more than six months ago. Study participants will take either vitamin D alone or in combination with omega-3 for one year, followed by a one-year observation period.

“We are at the very beginning…and I am very excited to able to test this hypothesis,” Ricordi said.

But he is cautious about creating hype about the therapy before it is tested.

“One of our problems is once you explain the trial, it’s so simple people are trying it on their own,” he said. In fact, there are tests that can be secured online to monitor omega-3 and vitamin D levels by doing a simple finger stick and mailing off a blood sample.

“But it should be done under medical supervision. I cannot recommend that anyone do a trial that is not proven yet,” Ricordi said. “I recommend enroll in the trial and get validation of the hypothesis or discuss this with your physician.”

It is also important to use a highly purified form of omega-3.

“You don’t want to get a cheap product that may have contaminants like mercury, especially if you are taking them at a higher dose,” he said.

Studying the effects of omega-3 and vitamin D could change health care as we know it, Ricordi said.

“There are trials studying the effects of the combination of omega-3 and vitamin D to prevent cardiovascular disease, stroke and cancer,” he said. “You’ll see many more trials coming up on this topic.”

Read more here: https://www.miamiherald.com/living/health-fitness/article221754140.html#storylink=cpy

[cherry]

Exercise Must Be a Prescription for Those With Type 2 Diabetes, European Cardiologists Say

Mary Caffrey

Keeping patients with diabetes motivated is the most challenging part of exercise, the authors say, as they call for psychologists and counselors to be part of the care team.

People with type 2 diabetes (T2D) need individual prescriptions for exercise, not finger-wagging from their doctors, according to a new position paper from the European Association of Preventive Cardiology.

The group is a branch of the European Society of Cardiology (ESC), which publishes the European Journal of Preventive Cardiology, where the paper appears Tuesday. “Just advising patients to exercise, which is what doctors typically do, is not enough,” first author Hareld Kemps, MD, a cardiologist with Maxima Medical Centre in the Netherlands, said in a statement. An actual prescription for exercise is needed, the authors say.

Kemps said that physicians must “take the lead” in calling for programs to be reimbursed by insurers.

Making movement a daily habit seriously lowers the risks associated with heart disease, which is the leading cause of death among people with T2D. It’s also the most cost-effective way to treat the disease, but it’s also the most difficult because so many people stumble when trying to stick with a fitness plan.

To address this, the paper encourages physicians to integrate exercise in a patient’s daily routine and increase their cardiorespiratory fitness over time. Showing the patient how measurable improvements are improving their health beyond what they see on the scale can keep patients motivated. The paper points out the need to work with a team of professionals, involving specialists such as psychologists and counselors, to help T2D patients achieve their goals.

Among the report’s recommendations and findings:

1. A patient’s cardiorespiratory fitness should be assessed with cardiopulmonary testing before an exercise program begins. Getting low-density lipoprotein cholesterol under control is important for patients who have not been active.
2. Each patient’s exercise plan should be customized, and doctors should increase goals as the patient hits fitness milestones.
3. Where possible, combining aerobic training and resistance training is the best way to improve glycemic control and muscle mass and function.
4. Both glycated hemoglobin (A1C) and cardiorespiratory fitness are important measures of the success of a training program.
5. Current evidence does not support or refute that exercise that that exercise reduces death rates in T2D patients, but there is evidence that exercise reduces microvascular complications that lead to disability, such as the loss of kidney function or nerve damage.
6. Improving vascular function is a good reason to exercise; it reduces the chance of a heart attack and eases symptoms such as erectile dysfunction, apart from the benefits for improving A1C.
7. Exercise can help control of lipids, but it does not replace medication like statins.

What kind of exercise is best?

While the report generally recommends a combination of aerobic activity, such as running, cycling, or swimming, to improve cardiovascular fitness; along with resistance training to build muscle mass, how this happens will vary with each patient.

Keeping patients engaged is key. “Motivation and thus adherence might be improved by early achievement of certain exercise training goals,” the authors state.

The paper specifically recommends aerobic training 3 to 5 times per week, and it discusses the benefits of high intensity interval training (HIIT), which allows patients to maximize heart rate in short bursts from 1 to 4 minutes. But the paper cautions that HIIT “requires high levels of motivation and capability of the patient,” demands more supervision, and calls for a structured training plan.

A simpler strategy is telling the patient to break up long periods of sitting by walking around and stretching.

Comorbidities

The paper discusses how to decide who can exercise, and which forms are safe for which patients. It calls for doctors to create “relevant and achievable targets,” including those that involve improving the quality of life. Some patients with T2D have serious health problems that would prevent certain types of exercise, or require them to slowly build up cardiorespiratory fitness over an extended period.

The paper spells out precautions and protocols for patients with arrhythmia, myocardial ischemia, cardiovascular autonomic neuropathy, and left ventricle dysfunction. Authors say those with peripheral artery disease should not perform high-intensity exercise. They recommend that patients be regularly checked for hypertension, glycemic status, and spell out when stress tests are required.

The main problem, however, is adherence, which the authors say “is severely affecting the outcome of many trials.”

[cherry]

Diabetes and Stress Hyperglycemia Linked with Worse Outcomes After Stroke

Written by Elizabeth Michaelson Monaghan

With William (Lik-Hui) Lau, MBBS, and Walter N. Kernan, MD

People with diabetes face greater complications after having a stroke. And, if you have diabetes, the chance that you might experience a cardiovascular event is 1.5 times greater than someone who doesn’t have diabetes.

In fact, patients with diabetes have poorer health outcomes and longer hospital stays when experiencing an ischemic stroke, the most common type of cerebrovascular event,1 according to a review published in Journal of Diabetes Investigation.

You may be interested in these related articles:

• New Type 2 Diabetes Treatment
• Safety of Type 2 Diabetes Medications
• Does Diabetes Raise Your Risk of Cancer?
• Gestational Diabetes and Childhood Obesity

In a review of 39 studies that encompassed nearly 360,000 patients,1 the investigators also found that an estimated 28% of people who had been hospitalized for a stroke had diabetes, indicating that diabetes was more common in stroke patients than in the general population.

Stress Hyperglycemia: A Warning to Patients with Diabetes

Stress hyperglycemia—a form of high blood sugar—is a condition brought on by an acute illness, or a cardiovascular event, and is usually discovered during a hospital stay. Stress hyperglycemia (incident high blood sugar) generally resolves after the patient recovers from the illness, but the effects can be long-lasting.2,3

"The most appropriate cutoff point for stress hyperglycemia in patients with pre-existing diabetes needs to be established, but certainly a patient with a well controlled (< 7%) hemoglobin A1Cc  (HbA1c) whose glucose concentration is consistently higher than the threshold defined for hospital-related hyperglycemia would qualify," according to Dr. Dungan. 

So you could  say, "stress hyperglycemia can be defined as a fasting blood sugar higher than 124 mg/dL (milligrams per deciliter of blood), 3,4 or a random blood sugar higher than 200 mg/dL for both patients with established, well-controlled diabetes and those without diabetes."4  

In patients, with or without diagnosed diabetes, stress hyperglycemia is associated with worse cardiac functioning after an ischemic stroke. But for patients without diabetes, stress hyperglycemia appears linked with more severe strokes—and a greater risk of dying.

“Stress hyperglycemia appears to be more consistently associated with poorer outcomes after stroke compared with established diabetes,” says the study first author, William (Lik-Hui) Lau, MBBS (equivalent to an MD from a US medical school) and confirmed by the senior author, Elif I. Ekinci, MBBS, PhD, associate professor at the University of Melbourne in Australia. This “supports the hypothesis that stress hyperglycemia reflects stroke severity.”

“However, even after adjusting for this, stress hyperglycemia and established diabetes are both still independently associated with poorer outcomes after stroke,” Dr. Lau tells EndocrineWeb. In addition, anyone who has a stroke should also be aware of their increased risk of experiencing another stroke event.1

Stress hyperglycemia is linked with other health issues as well. And in hospitalized patients, it’s associated with a greater likelihood of complications like sepsis, urinary tract infections, and pneumonia.5 Finally, in patients without no known diabetes, experiencing stress hyperglycemia raises the risk of diabetes.6

How Common Is Stress Hyperglycemia?

It’s difficult to estimate how many people experience stress hyperglycemia, since a patient with abnormally high blood sugar may actually have undiagnosed diabetes. Of the estimated 30 million people in the US with diabetes, 7.2 million, or nearly one in four people, have diabetes,7 according to the Centers for Disease Control and Prevention. "Not all patients are necessarily evaluated for diabetes during an inpatient stay,” says Dr. Lau.

The prevalence of nondiabetes-related stress hyperglycemia “has been quoted to be between 8-35 percent of patients who presented with an ischemic stroke,”8 says Dr. Lau. “This variability is in part due to the heterogeneity [or differences] in the definition of stress hyperglycemia between the studies”9 he says. For instance, the American Association of Clinical Endocrinologists and the American Diabetes Association have defined hyperglycemia as any blood sugar above 140 mg/dL.10

While Study Design is Lacking, Findings Raise Valid Concerns

The findings of the meta-analysis and literature review are intriguing, but the methods used to leave room for some questions, says Walter N. Kernan, MD, professor of medicine at Yale School of Medicine in New Haven, Connecticut.

“I’m not sure that they looked at evidence from clinical trials. I was able to identify at least one paper in this field that they did not include in their analysis,” he tells EndocrineWeb. Nonetheless “I don’t have criticisms of the findings—that diabetes is common among patients with stroke, and is associated with adverse outcomes.”

“I think this field is rapidly moving towards greater insights about the role of diabetes in affecting outcome after stroke,” says Dr. Kernan who was not involved in this study. “This paper is addressing a really important area in vascular neurology that’s full of promise.” The recommended treatment for stress hyperglycemia is to begin patients on insulin and with very close monitoring of blood sugar levels.11,12

To prevent a second episode, or recurrence of vascular events such as heart attack or stroke, often heralded by a surge in blood sugar, “two new agents, SGLT2i (sodium-glucose cotransporter 2 inhibitors) and the GLP-1 (glucagon-like peptide-1) receptor agonists are effective at lowering the risk for major adverse cardiac events in patients with type 2 diabetes, as these patients are at higher risk for, or who have, vascular disease,”13,14 says Dr. Kernan.

Furthermore, the recent Insulin Resistance Intervention After Stroke (IRIS) trial found that in patients with prediabetes who experienced an ischemic stroke, the diabetes medication pioglitazone can “substantially reduce the risk for stroke and myocardial infarction [heart attack],” 15 says Dr. Kernan. He points out that prediabetes is “at least as common as diabetes” in patients with ischemic stroke. 

Need for Further Research on the Relationship of Hyperglycemia and Stroke

“Larger, more robust studies using defined diabetes diagnostic and stroke outcome measures are needed,” Dr. Lau tells EndocrineWeb. “Specifically, the use of combined glucose testing to include fasting blood glucose, glucose tolerance testing, and hemoglobin A1c to determine if—and how—these measures estimate the true prevalence of existing and newly diagnosed diabetes, and can predict outcomes in both ischemic and hemorrhagic stroke.

The HbA1c test, which estimates average blood sugar control over the past three months, may be a particularly valuable measure since HbA1c results not only remain unaffected by stress hyperglycemia, but higher HbA1c levels are also linked with worse outcomes—including stroke recurrence and greater risk of death—after stroke.

Finally, Dr. Lau concludes, “Whether the treatment of stress hyperglycemia improves stroke outcomes is an important question to answer.”