What question did this study set out to answer?

This study aims to identify which glucose monitoring metric better predicts outcomes in patients with acute ischemic stroke.

May 8, 2026Open Access

Abstract Number: Esoc2026a585 Time in Glycemic Range Versus Hyperglycemia Exposure: Identifying the Best Prognostic Metric in Ischemic Stroke. The Glias-Iii Study

Key Points

This study aims to identify which glucose monitoring metric better predicts outcomes in patients with acute ischemic stroke.
Multicenter cohort prospective study monitoring glycemic metrics using continuous glucose monitors within 24 hours post-stroke.
Defined time in range (TIR) and time above range (TAR) and analyzed their association with death or dependence at 3 months.
Performed adjusted multivariate analysis on collected data from 153 patients.
29.4% of patients were dead or dependent at 3 months; lower median TIR in these patients (89% vs 93%; P=0.100).
Higher TAR was significantly associated with death or dependence (mean TAR 8% vs 2%).
TAR showed a positive association with outcomes (OR 1.018; 95% CI 1.004-1.032), while TIR did not (OR 0.98; 95% CI 0.969-1.006).

Abstract

Abstract Background and aims Post-stroke hyperglycemia has a well-known negative prognostic value in acute ischemic stroke (AIS). Continuous glucose monitors (CGM) provide an opportunity to analyze other metrics of glucose control such as time in range (TIR) and time above range (TAR). We aim to explore which of them provides a better prognostic prediction. Methods The GLycemia In Acute Stroke (GLIAS) III is a multicenter cohort prospective study. Blinded CGMs were implanted within the first 24 h. We defined TIR as the proportion of time within 70-150 mg/dL and TAR as the proportion of time with values above 150 mg/dL. Adjusted multivariate models for death or dependence at 3 months were built. Results A total of 153 patients were included (61 female;39.9%). CGMs were implanted a median of 18 hours (IQR 10.98-21.98) after stroke onset. The median duration of monitoring was 84.67 hours. 45 patients (29.4%) were dead or dependent at 3 months. Their median TIR was slightly lower than in independent patients (89% vs 93%; P=0.100) while mean TAR was significantly higher (8% vs. 2%). A non-significant gradient between TIR quartile and death or dependence was observed (Q1 47.1%, Q2 33.3%, Q3 26.7%, Q4 23.5%). Adjusted multivariate analysis showed that TAR was associated with a higher likelihood of death or dependence (OR 1.018; 95%CI 1.004-1.032) whilst TIR was not (OR 0.98; 95%CI 0.969-1.006). Conclusions In this prospective, multicenter cohort study, time above 150 mg/dL was a better metric to predict death or dependence at 3 months in patients with AIS. Conflict of interest The study was investigator-initiated, promoted and coordinated by the Research Foundation of the La Paz University Hospital (Fundación de Investigación del Hospital Universitario La Paz) and was co-funded by grants (PI18/00991, PI21/00962) from the Carlos III Health Institute (ISCIII) Health Care Research Fund and the European Regional Development Fund (ERDF). Conflict of interest statement for all the authors: nothing to disclose

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