In the Journals

Diabetes, stress hyperglycemia worsen stroke outcomes

Patients with diabetes and/or stress hyperglycemia are at a higher risk for poorer stroke outcomes than the general population, according to findings published in the Journal of Diabetes Investigation.

Lik-Hui (William) Lau

“Diabetes is a growing chronic disease globally, and it has implications on patient recovery after an acute stroke,” Lik-Hui (William) Lau, MBBS, an endocrinology advanced trainee at Austin Health in Victoria, Australia, and Elif I. Ekinci, PhD, director of diabetes at Austin Health, told Endocrine Today. “A robust method to predict the effects of diabetes and stress hyperglycemia on outcomes after stroke are needed that will enable us to target treatment toward this high-risk group.”

Lau, Ekinci and colleagues conducted a literature review and meta-analysis using a search of the Ovid Medicine and Ovid Embase databases for studies published between 2004 and 2017 that examined stroke populations and the prevalence of diabetes. The researchers identified 66 articles encompassing data from 522,645 patients for inclusion, and meta-analysis was conducted on 39 studies (n = 359,783).

The prevalence rate for diabetes in patients with stroke was 28% (95% CI, 26-31), which was higher than the estimated 20% to 33% rate in the general population, according to researchers. Patients with ischemic stroke were more likely to have diabetes (33%; 95% CI, 28-38) than those with hemorrhagic stroke (26%; 95% CI, 19-33). In studies in which HbA1c was the only metric used to diagnose diabetes, the prevalence in stroke populations was 37% (95% CI, 27-47).

The researchers also noted that diabetes prevalence was highest in Southeast Asia (33.5%) and East Asia (32.3%), whereas rates in North America (27.5%) and Europe (26.4%) were lower.

In addition to higher diabetes prevalence, the researchers found that patients with stroke and diabetes had longer hospital stays and poorer neurologic outcomes after stroke. Stroke severity, mortality rates and stroke recurrence were generally elevated for those with high HbA1c levels. Stress hyperglycemia also played a part in worsening stroke outcomes and mortality.

Elif I. Ekinci

“Stress hyperglycemia appears to be more consistently associated with poorer outcomes after stroke compared with established diabetes or chronic dysglycemia, which supports the hypothesis that stress hyperglycemia reflects stroke severity,” Lau and Ekinci said. “However even after adjusting for this, stress hyperglycemia and established diabetes are still independently associated with poorer outcomes after stroke. A combination of glucose-based diagnostic testing (ie, fasting plasma glucose and oral glucose tolerance test) and HbA1c may be a more effective method of predicting outcome after stroke.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.

Patients with diabetes and/or stress hyperglycemia are at a higher risk for poorer stroke outcomes than the general population, according to findings published in the Journal of Diabetes Investigation.

Lik-Hui (William) Lau

“Diabetes is a growing chronic disease globally, and it has implications on patient recovery after an acute stroke,” Lik-Hui (William) Lau, MBBS, an endocrinology advanced trainee at Austin Health in Victoria, Australia, and Elif I. Ekinci, PhD, director of diabetes at Austin Health, told Endocrine Today. “A robust method to predict the effects of diabetes and stress hyperglycemia on outcomes after stroke are needed that will enable us to target treatment toward this high-risk group.”

Lau, Ekinci and colleagues conducted a literature review and meta-analysis using a search of the Ovid Medicine and Ovid Embase databases for studies published between 2004 and 2017 that examined stroke populations and the prevalence of diabetes. The researchers identified 66 articles encompassing data from 522,645 patients for inclusion, and meta-analysis was conducted on 39 studies (n = 359,783).

The prevalence rate for diabetes in patients with stroke was 28% (95% CI, 26-31), which was higher than the estimated 20% to 33% rate in the general population, according to researchers. Patients with ischemic stroke were more likely to have diabetes (33%; 95% CI, 28-38) than those with hemorrhagic stroke (26%; 95% CI, 19-33). In studies in which HbA1c was the only metric used to diagnose diabetes, the prevalence in stroke populations was 37% (95% CI, 27-47).

The researchers also noted that diabetes prevalence was highest in Southeast Asia (33.5%) and East Asia (32.3%), whereas rates in North America (27.5%) and Europe (26.4%) were lower.

In addition to higher diabetes prevalence, the researchers found that patients with stroke and diabetes had longer hospital stays and poorer neurologic outcomes after stroke. Stroke severity, mortality rates and stroke recurrence were generally elevated for those with high HbA1c levels. Stress hyperglycemia also played a part in worsening stroke outcomes and mortality.

Elif I. Ekinci

“Stress hyperglycemia appears to be more consistently associated with poorer outcomes after stroke compared with established diabetes or chronic dysglycemia, which supports the hypothesis that stress hyperglycemia reflects stroke severity,” Lau and Ekinci said. “However even after adjusting for this, stress hyperglycemia and established diabetes are still independently associated with poorer outcomes after stroke. A combination of glucose-based diagnostic testing (ie, fasting plasma glucose and oral glucose tolerance test) and HbA1c may be a more effective method of predicting outcome after stroke.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.