Continuous glucose monitoring and glycaemic variability in acute ischaemic stroke: a systematic review with narrative synthesis.

Dysglycaemia is common after acute ischaemic stroke and is associated with adverse outcomes. Continuous glucose monitoring (CGM) provides frequent interstitial glucose measurements and may identify glycaemic variability and excursions missed by intermittent testing. This systematic review evaluated CGM feasibility, accuracy, glycaemic patterns and clinical associations in acute ischaemic stroke. MEDLINE, Embase and CENTRAL were searched to January 2026 for studies of adults undergoing CGM within seven days of stroke onset or admission. Risk of bias was assessed using RoB 2 or the Newcastle-Ottawa Scale, and certainty of evidence using GRADE. Seven studies enrolled 595 participants; monitoring lasted 24 h to 4.5 days. Mean glucose ranged from approximately 118 to 149 mg/dL and coefficient of variation from 4% to 21%. Observational studies provided low- or very-low-certainty evidence that greater hyperglycaemic exposure or variability was associated with death or dependency, unfavourable outcome after thrombectomy and reduced in-hospital neurological improvement. An unadjusted time-above-range difference between functional-trajectory groups was not independently significant after adjustment. One diabetes-only randomised trial evaluated a multi-component intervention combining structured nursing, insulin-pump therapy and CGM. Two-week neurological, motor, self-care and quality-of-life measures favoured the intervention, but modified Rankin Scale and longer-term outcomes were not reported, and the effect of CGM could not be isolated. CGM appears feasible, but evidence is heterogeneous and insufficient to support routine implementation. Standardised metrics and adequately powered multicentre trials are required.