***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND AND PURPOSE Hyperglycemia at the time of ischemic stroke is associated with increased mortality and morbidity . Animal studies suggest that infa rct expansion may be responsible . The influence of persisting hyperglycemia after stroke has not previously been examined . We measured the blood glucose profile after acute ischemic stroke and correlated it with infa rct volume changes using T2- and diffusion-weighted MRI . METHODS We recruited 25 subjects within 24 hours of ischemic stroke symptoms .  Continuous glucose monitoring was performed with a glucose monitoring device ( CGMS ) , and 4-hour capillary glucose levels ( BGL ) were measured for 72 hours after admission .  MRI and clinical assessment s were performed at acute ( median , 15 hours ) , subacute ( median , 5 days ) , and outcome ( median , 85 days ) time points . RESULTS Mean CGMS glucose and mean BGL glucose correlated with infa rct volume change between acute and subacute diffusion-weighted MRI ( r > or=0.60 , P<0.01 ) , acute and outcome MRI ( r=0.56 , P=0.01 ) , outcome National Institutes of Health Stroke Scale ( NIHSS ; r > or=0.53 , P<0.02 ) , and outcome modified Rankin Scale ( mRS ; r > or=0.53 , P=0.02 ) . Acute and final infa rct volume change and outcome NIHSS and mRS were significantly higher in patients with mean CGMS or mean BGL glucose > or=7 mmol/L. Multiple regression analysis indicated that both mean CGMS and BGL glucose levels > or=7 mmol/L were independently associated with increased final infa rct volume change . CONCLUSIONS Persistent hyperglycemia on serial glucose monitoring is an independent determinant of infa rct expansion and is associated with worse functional outcome . There is an urgent need to study normalization of blood glucose after stroke BACKGROUND diabetes mellitus not only increases the risk of ischaemic stroke two- to four-fold but also adversely inXuences prognosis . The prevalence of recognised diabetes mellitus in acute stroke patients is between 8 and 20 % , but between 6 and 42 % of patients may have undiagnosed diabetes mellitus before presentation . Post-stroke hyperglycaemia is frequent and of limited diagnostic value and the oral glucose tolerance test assumes that the patient is clinical ly stable and eating normally . There is a need for a simple and reliable method to predict new diabetes mellitus in acute stroke patients . OBJECTIVES to determine the prevalence of unrecognised diabetes mellitus and impaired glucose tolerance on hospital admission and 12 weeks later in acute stroke patients with post-stroke hyperglycaemia > or = 6.1 mmol/l . To measure the accuracy of hyperglycaemia and elevated glycosylated haemoglobin concentration in predicting the presence of unrecognised diabetes mellitus at 12 weeks . DESIGN acute ( < 24 hours ) stroke patients ( cerebral infa rct ion and primary intracerebral haemorrhage ) with admission hyperglycaemia between 6.0 and 17 mmol/l and without a previous history of insulin-treated diabetes mellitus who were r and omised into the Glucose Insulin in Stroke Trial between October 1997 and May 1999 were studied . The Glucose Insulin in Stroke Trial is a r and omised controlled trial investigating the benefits of maintaining euglycaemia in acute stroke patients with mild to moderate hyperglycaemia . At 12 weeks , survivors underwent a 75 g oral glucose tolerance test . The positive predictive value and negative predictive value of admission plasma glucose > or = 6.1 mmol/l and elevated glycosylated haemoglobin concentration in predicting the presence of diabetes mellitus were used to estimate the prevalence of unrecognised diabetes mellitus in a consecutive series of 582 acute stroke admissions . RESULTS 582 consecutive acute stroke patients were assessed for eligibility for the Glucose Insulin Stroke Trial , of whom 83 ( 14 % ) had recognised diabetes mellitus . One hundred and forty-two patients were r and omised and 62 underwent a 3-month oral glucose tolerance test , of whom 26 ( 42 % ) had normal glucose tolerance , 23 ( 37 % ) had impaired glucose tolerance and 13 ( 21 % ) had diabetes mellitus . Admission plasma glucose > or = 6.1 mmol/l and glycosylated haemoglobin > or = 6.2 % predicted the presence of previously unrecognised diabetes mellitus at 12 weeks with a positive predictive value of 80 % and negative predictive value of 96 % . The estimated prevalence of unrecognised diabetes mellitus in the total series of acute stroke admissions was 16 - 24 % . CONCLUSIONS one-third of all acute stroke patients may have diabetes mellitus . For patients presenting with post-stroke hyperglycaemia , impaired glucose tolerance or diabetes mellitus is present in two-thirds of survivors at 12 weeks . Admission plasma glucose  > or = 6.1 mmol/l combined with glycosylated haemoglobin > or = 6.2 % are good predictors of the presence of diabetes mellitus following stroke In a prospect i ve study to correlate admission glucose level with neurologic outcome in stroke , 252 acute stroke patients without prior disability and admitted within 24 hours of onset of ictus were assessed . The stroke was classified into one of three types -- cortical infa rct , lacunar infa rct , or intracerebral hemorrhage -- by clinical , computed tomographic , and necropsy findings . Fifty-one diabetic patients were excluded from the entire cohort to form a nondiabetic category for analysis . We found that admission glucose level showed a significantly higher degree of correlation with mortality and morbidity ( measured as arm function , leg function , and activities of daily living ) when cortical ( n = 118 ) and lacunar ( n = 58 ) infa rcts were pooled compared with when they were assessed separately . For intracerebral hemorrhage ( n = 76 ) , admission glucose level correlated with mortality but not morbidity . This trend persisted despite exclusion of diabetic patients . These results are consistent with previous observations of a correlation between a high admission glucose level and the severity of stroke . The importance of segregating cortical from lacunar infa rcts , two groups with a different natural history and prognosis , in any future analysis is emphasized From August 1987 through December 1989 all consecutive conscious patients younger than 70 years with a recent ( less than 48 h ) brain infa rct ion of the carotid territory were prospect ively included in the study .  Blood sample s for fasting blood glucose and glycosylated haemoglobin ( HbA1c ) were taken after a median delay of 23 h of the onset of symptoms . The severity of hemiparesis was assessed on admission , at 1 week , 3 weeks , and 3 months . The functional outcome was assessed at 3 months . Computed cerebral tomography was performed on admission , and later on at 3 weeks or 3 months . The brain infa rct volume was measured from the CTs . The patients were diagnosed to have prestroke normoglycemia ( n = 76 ) and prestroke hyperglycemia ( n = 23 ) on basis of the HbA1c level . The case fatality rate , severity of hemiparesis , functional outcome , and infa rct size did not differ between these 2 groups . On the other h and , fasting blood glucose level of the non-diabetics correlated strongly with the severity of hemiparesis and predicted stroke outcome . A statistically significant correlation was observed between blood glucose values and the volumes of cortical infa rcts in non-diabetics . Because prestroke blood glucose level , in contrast to post-stroke blood glucose level , did not have any predictive value concerning stroke outcome it is concluded that high fasting blood glucose values after stroke reflect a stress response to a more severe ischemic brain lesion BACKGROUND The adrenal glucocorticoid stress response in humans causes catabolism , increasing blood glucose and heart rate , and possibly potentiates ischaemic damage to neurons . These effects could induce secondary brain damage in acute stroke . MATERIAL S AND METHODS This prospect i ve study was based on a single determination of s-cortisol in 172 patients included within 24 h of stroke onset , 50 % within 12 h of stroke onset . All patients were admitted to hospital within 6 h of stroke onset . We investigated the relations of s-cortisol to neurological deficit measured by Sc and inavian Stroke Scale ( SSS ) , lesion volume on CT-scan , blood glucose on admission , pulse rate , blood pressure , body temperature , deteriorating stroke , cytokines and cytokine receptors , and outcome . RESULTS In a multivariate logistic regression analysis , s-cortisol was independently related to death within 7 days of stroke onset , odds ratio ( OR ) Cortisol(+100 nmol/l ) 1.9 ( 95 % CI 1.01 - 3.8 ) ; serum-cortisol was , however , not a predictor of death or dependency within 3 months . S-cortisol correlated to SSS ( rho=-0.45 , p<0.001 ) , body temperature ( rho=0.27 , p<0.001 ) , pulse rate ( rho=0.26 , p<0.001 ) , and lesion volume ( rho=0.33 , p<0.001 ) . S-cortisol was related to the presence of insular damage . CONCLUSION Acute stroke mortality related to increasing serum-cortisol levels . S-cortisol was associated with stroke severity and markers reflecting stroke severity Background Screening for undiagnosed diabetes in patients with acute myocardial infa rct ion is recommended ( ESC and EASD Task Force 2007 ) . Glucose tolerance testing in the peri-infa rct period may not be valid because of confounding , e.g. by the acute stress reaction . The aim was to evaluate undiagnosed diabetes ( DM ) and impaired glucose regulation ( IGR ) in AMI during hospital stay and 3 months after discharge . Material s and methods In 96 consecutively admitted AMI patients ( Heart Center Wuppertal , Germany )  OGTT were performed , of whom in 62 OGTT were also carried out 3 months later . Results Before discharge 32 % of the patients had newly diagnosed diabetes and 47 % patients had prediabetes ( IGR ) . Glucose tolerance was normal in 20 ( 21 % ) patients only . After 3 months , 74 % with newly diagnosed DM at baseline still had disturbed glucose metabolism ( 58 % DM , 16 % IGT ) . No patient with normal OGTT became diabetic after 3 months . In multivariate regression , the odds of having diabetes ( 3 months ) was about sixfold higher when having diabetes before discharge ( OGTT ) . Admission glucose , infa rct ion size CKMAX , and inflammation ( CRP ) were not significantly related to OGTT results . Conclusions This prospect i ve study confirms a high prevalence of undiagnosed DM in patients with AMI . In about 60 % of AMI patients , newly diagnosed DM persisted after 3 months . For the first time we could show that there is no correlation between infa rct ion size and undiagnosed diabetes . Thus , an OGTT performed before discharge may provide a reliable measure of disturbed glucose regulation but needs to be repeated AIMS To assess the cardiovascular disease ( CVD ) risk of people with screen-detected Type 2 diabetes and to estimate the risk reduction achievable through early intensive pharmacological intervention . METHODS In ADDITION-Cambridge , diabetic patients were identified among people aged 40 - 69 years through a stepwise screening procedure including a risk score , r and om and fasting capillary blood glucose , HbA(1c ) and oral glucose tolerance test . In those without prior macrovascular disease , 10-year CVD risk was computed using UK Prospect i ve Diabetes Study ( UKPDS ) and Framingham engines . The absolute risk reduction achievable and its plausible range were predicted using relative risk reductions for individual therapies from published trials and sensitivity analysis . RESULTS Of the 867 individuals with undiagnosed diabetes , 19 % had pre-existing CVD , 97 % were overweight or obese , 86 % had hypertension , 75 % had dyslipidaemia , 20 % had microalbuminuria and 18 % were smokers . Of those with hypertension , 35 % were not prescribed drugs and 42 % were suboptimally treated . Of participants with dyslipidaemia , 68 % were not prescribed medications and 22 % were poorly controlled . Median 10-year CVD risk was 34.0%[interquartile range ( IQR ) 26.2 - 44.6 ] in men and 21.5 % ( IQR 15.7 - 28.7 ) in women using the UKPDS engine ; 38.6 % ( IQR 27.8 - 53.0 ) in men and 24. 
    Output:
    
In this study hyperglycaemia in the setting of an acute stroke was transient in the majority of patients