Hyperglycaemia in patients with acute ischaemic stroke: how often do we screen for undiagnosed diabetes?
BACKGROUND
Hyperglycaemia is common among patients with acute ischaemic stroke, and may be due to the physiological stress of the acute stroke event or reflect underlying diabetes mellitus. The under-diagnosis of diabetes in the general population, combined with the association of diabetes and stroke, suggests a rationale for screening for diabetes among hyperglycaemic stroke patients.


OBJECTIVE
To determine how often clinicians screen for diabetes among hyperglycaemic stroke patients without a prior diagnosis of diabetes.


METHODS
Retrospective medical record review.


METHODS
We reviewed the records of acute ischaemic stroke patients admitted at any of ten Connecticut hospitals from May 1996 through December 1998.


RESULTS
We identified 90 acute stroke patients with no prior history of diabetes. The prevalence of hyperglycaemia varied from 31% down to 6%, depending on the maximum glucose cut-off used to define hyperglycaemia: from > or = 140 mg/dl (7.8 mmol/l) to > or = 200 mg/dl (11.1 mmol/l). Only one of the hyperglycaemic patients (1/90, 1%) had any evidence that a clinician screened or planned to screen for undiagnosed diabetes: one patient had a haemoglobin A1c measured during the hospitalization, none received oral glucose tolerance testing while hospitalized, and no discharge summary included a plan to screen for diabetes as an out-patient.


CONCLUSIONS
Hyperglycaemic stroke patients without a previous diagnosis of diabetes are not routinely screened for diabetes. This situation represents an opportunity, currently unused, to identify an important and modifiable condition.
Bravata
D M
DM
Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA. Dawn.Bravata@yale.edu
Kim
N
N
Concato
J
J
Brass
L M
LM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000175:diagnosis*; D003925:Diabetic Angiopathies / Q000097:blood*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood*
D001786:Blood Glucose