Impact of Glycemic Trajectory and Variability on Ischemic Stroke Prognosis and Exploration of Its Mechanisms: A Comprehensive Review

The association between glycemic trajectories and variability with new-onset stroke and stroke outcomes remains poorly understood. Previous studies have predominantly focused on the absolute levels of single-point glucose measurements and emphasized mean glucose levels, overlooking individual differences in baseline levels and variability. This study describes prior research exploring the relationship between glucose trajectories and variability with post-stroke hemorrhagic transformation, short- and long-term clinical outcomes, post-stroke pain, post-stroke depression, and post-stroke cognitive impairment. It also discusses approaches to achieving precise and standardized measurement of glucose trajectories and variability, as well as existing methods for effectively improving glucose fluctuations. The findings suggest that abnormal glucose trajectories and high variability are independently associated with adverse stroke outcomes. However, significant gaps remain regarding standardization of variability metrics, integration of continuous glucose monitoring into acute stroke care, and the lack of prospective interventional data. Future research should prioritize the establishment of unified assessment standards and well-designed prospective studies to translate these findings into clinical practice.