title: Impaired glucose metabolism in patients with acute stroke and no previous diagnosis of diabetes mellitus.
abstract: BACKGROUND
  About a third of patients with acute stroke and no prior diagnosis of diabetes have hyperglycaemia during the acute phase of stroke. Whether this is an acute stress response or a reflection of underlying diabetes is controversial.
  
  
  OBJECTIVE
  To assess whether impaired glucose metabolism in patients with acute ischaemic stroke and no previous diagnosis of diabetes persists after 3 months, and whether such persistence can be predicted.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  We enrolled 106 patients with acute ischaemic stroke and no history of diabetes. Fasting blood glucose, serum insulin and the insulin resistance index HOMA were recorded during hospital stay. A standard oral glucose tolerance test was performed at discharge and 3 months later.
  
  
  RESULTS
  Ten patients did not complete the study. Eighty-one patients (84.4%) had abnormal glucose metabolism at discharge and 62 (64.6%) after 3 months. Thirty-seven (38.5%) had impaired glucose tolerance at discharge and 26 (27.1%) after 3 months. Forty-four (45.8%) had diabetes at discharge, and 36 (37.5%) at 3 months. Post-load hyperglycaemia at discharge was a predictor of diabetes after 3 months. A plasma glucose cut-off of 11.7 mmol/l (210 mg/dl) had a specificity of 90.0% and a positive predictive value of 81.3%. HOMA increased progressively from patients with normal glucose metabolism to those with newly diagnosed diabetes.
  
  
  CONCLUSIONS
  Impaired glucose tolerance and previously unrecognized diabetes could be detected early in the stroke course, and persisted after 3 months in more than two-thirds of our patients. Post-load hyperglycaemia during the acute phase of stroke may be useful in identifying patients with abnormal glucose metabolism, which places them at risk for adverse outcomes, including cardiovascular disease.
authors.affiliation: Unità Operativa di Medicina Interna, Ospedale S. Elia, Caltanisetta, Italy. fvanche@tin.it
authors.forename: F
authors.initials: F
authors.lastname: Vancheri
authors.forename: M
authors.initials: M
authors.lastname: Curcio
authors.forename: A
authors.initials: A
authors.lastname: Burgio
authors.forename: S
authors.initials: S
authors.lastname: Salvaggio
authors.forename: G
authors.initials: G
authors.lastname: Gruttadauria
authors.forename: M C
authors.initials: MC
authors.lastname: Lunetta
authors.forename: R
authors.initials: R
authors.lastname: Dovico
authors.forename: M
authors.initials: M
authors.lastname: Alletto
mesh_terms: D000208:Acute Disease; D000368:Aged; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000378:metabolism*; D005260:Female; D018149:Glucose Intolerance / Q000378:metabolism*; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D020521:Stroke / Q000378:metabolism*
chemical_list: D006442:Glycated Hemoglobin