Glycemic instability is common among critically ill patients with ischemic stroke and can strongly influence outcomes. A large cohort analysis published in Diabetology & Metabolic Syndrome found that advanced glycemic markers such as HGI, SHR, and GV predicted mortality differently in patients with and without diabetes.

The study included 1,293 patients admitted to intensive care (mean age 68 years, 67 percent male), with 640 having diabetes and 653 without. Marker values were derived from admission glucose and baseline HbA1c, and mortality was tracked at 30, 180, and 360 days.

Among patients without diabetes, moderate HGI was linked to lower 180-day (HR 0.64, p = 0.049) and 360-day mortality (HR 0.65, p = 0.023). Stress hyperglycemia ratio predicted higher 30-day mortality (HR 1.52, p = 0.009), and glycemic variability was associated with increased 360-day mortality (HR 1.50, p = 0.015). In patients with diabetes, only SHR consistently predicted 180-day mortality (HR 1.46, p = 0.028).

These findings show that patients without diabetes are more susceptible to stress-related glucose fluctuations after ischemic stroke. Incorporating diabetes-specific glycemic assessment in critical care may improve risk prediction and guide individualized management strategies.