The goal of this randomized clinical trial is to evaluate whether continuous glucose monitoring (CGM) can be used to guide glucose management in patients with type 2 diabetes who are admitted with an acute ischemic stroke and undergo endovascular therapy. Hyperglycemia frequently occurs during hospitalization in stroke and is associated with worse neurological and clinical outcomes. In current clinical practice, glucose levels are monitored using intermittent point-of-care testing (POCT) with finger-prick measurements, which may miss clinically relevant glucose fluctuations. CGM provides continuous glucose measurements and may allow earlier detection of hyperglycemia and more timely glucose management. This study is designed as a non-inferiority randomized controlled trial comparing CGM-guided glucose management with standard POCT-guided glucose management. The primary objective is to determine whether CGM-guided glucose management is non-inferior to POCT-guided management in terms of percentage time spent in hyperglycemia (glucose \>10 mmol/L) during the first 72 hours of hospitalization. Researchers will compare CGM-guided glucose management to POCT-guided glucose management to evaluate whether CGM can be used as an alternative strategy to guide glucose control in hospitalized stroke patients. Participants will: * Be randomly assigned to either CGM-guided glucose management or standard POCT-guided glucose management * Have their glucose levels continuously monitored (blinded in the POCT-guided group) during hospitalization * Receive glucose management according to the assigned monitoring strategy, based on the hospital insulin protocol
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
82
Continuous glucose monitoring using the FreeStyle Libre systems (Abbott Diabetes Care) to measure interstitial glucose levels through a subcutaneous sensor that continuously records glucose concentrations during hospitalization.
Intermittent glucose monitoring using point-of-care finger-prick capillary blood glucose measurements according to the hospital glucose management protocol.
Time spent in hyperglycemia (>10 mmol/L)
Percentage of time during hospitalization with glucose levels above 10 mmol/L measured using continuous glucose monitoring.
Time frame: During the first 72 hours of hospitalization
Duration of hyperlgycemic episodes (>10 mmol/L)
Duration of hyperglycemic episodes (\>10 mmol/L) measured using continuous glucose monitoring.
Time frame: During the first 72 hours of hospitalization
Duration of hypoglycemic episodes (<3.9 mmol/L)
Duration of hypoglycemic episodes (\<3.9 mmol/L) measured using continuous glucose monitoring.
Time frame: During the first 72 hours of hospitalization
Time in normoglycemia (3.9-10.0 mmol/L)
Percentage of time with glucose levels between 3.9-10.0 mmol/L measured using continuous glucose monitoring.
Time frame: During the first 72 hours of hospitalization
Time in hypoglycemia (<3.9 mmol/L)
Percentage of time with glucose levels \<3.9 mmol/L measured using continuous glucose monitoring
Time frame: During the first 72 hours of hospitalization
In-hospital complications
Occurrence of in-hospital complications, including infection, symptomatic intracranial hemorrhage, and delirium during hospitalization.
Time frame: During the first 72 hours of hospitalization
Neurological recovery
Neurological recovery assessed by change in National Institutes of Health Stroke Scale (NIHSS) score (range 0-42, higher scores indicate more severe neurological deficit) from baseline to 24 hours post-EVT. Early neurological improvement is defined as a ≥4-point decrease in NIHSS score, and major neurological improvement as a ≥8-point decrease or NIHSS ≤1.
Time frame: Baseline to 24 hours post-EVT
Good functional outcome
Good functional outcome defined as a modified Rankin Scale (mRS) score ≤2 (range 0-6, lower scores indicate better functional outcome).
Time frame: 3 months post stroke
Health-related quality of life
Health-related quality of life measured using the PROMIS-10 Global Health questionnaire (range 10-50, higher scores indicate better health-related quality of life).
Time frame: 3 months post stroke
All-cause mortality
Time frame: 3 months post stroke
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