• Sherita Hill Golden, Felicia Hill-Briggs, Kathleen Williams, Karen Stolka, and R Samuel Mayer.
• Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. sahill@jhmi.edu
• Arch Phys Med Rehabil. 2005 Dec 1; 86 (12): 2377-84.

ObjectivesTo summarize evidence on the impact of hyperglycemia on stroke outcomes and to present therapy algorithms for inpatient management in diabetic stroke patients.Data SourcesGuidelines for inpatient management of diabetes were reviewed and extracted from a technical review and recommendations from 2 national diabetes and endocrine organizations. MEDLINE database searches were conducted using key words: stroke, diabetes, hyperglycemia, hypoglycemia, inpatient, hospitalized, treatment, outcomes, disability, self-management, and education.Study SelectionStudies were selected that specifically addressed the impact of the following in stroke patients: hyperglycemia and diabetes on rehabilitation outcomes, management strategies for hyperglycemia and diabetes, and strategies for facilitating diabetes self-management.Data ExtractionTwo authors independently extracted data and management practices from selected articles and published practice guidelines.Data SynthesisDiabetes is prevalent in stroke patients and results in poorer inpatient hospital and rehabilitation outcomes. Management of diabetes in stroke patients is further complicated by impairments in mobility and vision, necessitating accommodation strategies and tools for self-management. Optimal management of hyperglycemia using insulin or oral hypoglycemic agents results in reduced morbidity and mortality among diabetic inpatients.ConclusionsTo achieve inpatient glycemic management targets, use of clinical management algorithms, self-management tools, and systems approaches such as diabetes management teams are useful.

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