LAUSR

In the United States, diabetes mellitus is the seventh leading cause of death, and 65% of these deaths are attributable to cardiovascular disease or stroke or to both.1,2 Moreover, diabetes mellitus is an established and independent risk factor for stroke and is associated with a 1.8- to ≈6-fold increased risk compared with nondiabetic subjects.2,3 Currently, 12.2% (30.3 million) US adults over the age of 18 years has diabetes mellitus with 23.8% (7.2 million) unaware they have diabetes mellitus.1 Prediabetes, a precursor to type 2 diabetes mellitus, is estimated to occur in 33.9% (84.1 million) US adults.1 Moreover, a meta-analysis of 102 prospective studies reported that persons with diabetes mellitus had a 2.3× higher risk of developing ischemic stroke and a 1.6× higher risk of developing hemorrhagic stroke compared with nondiabetics.4 Among patients admitted for acute stroke, diabetes mellitus was associated with a higher risk of death, functional dependency, and stroke recurrence.5,6 Hyperglycemia is a common problem in persons with diabetes mellitus after an acute stroke.5,6 Elevations in serum glucose can be because of many factors, such as age, obesity, and physiological stress. Maintaining therapeutic blood glucose levels postacute stroke can present extreme challenges. Therefore, reasonably tight, yet therapeutic, control of hyperglycemia in persons with diabetes mellitus after a stroke must be a priority. The purpose of this article is to describe (1) major evidence-based interventions to maintain normal glucose levels and improve outcomes in persons with diabetes mellitus after an acute stroke, and (2) the critical role nurses play in the prevention and control of hyperglycemia in persons with diabetes mellitus after a stroke. Several mechanisms associated with diabetes mellitus lead to stroke. Persons with diabetes mellitus have stiffer arteries, early structural changes, and decreased …