Disorders of glucose metabolism in acute stroke patients: an underrecognized problem.
OBJECTIVE
To determine the prevalence of disturbances in glucose metabolism in patients with acute stroke.


METHODS
Consecutively admitted acute stroke patients (n = 286) were screened for glucose tolerance according to the standardized World Health Organization protocol in the 1st and 2nd week after the stroke event. In addition, we repeatedly measured fasting capillary blood glucose during the first 10 days.


RESULTS
Measurements were not performed or cancelled if patients were not fully conscious or had severe dysphagia or early complications that made transfers to other hospitals necessary (n = 48). Of the remaining 238 patients, 20.2% had previously known diabetes; 16.4% were classified as having newly diagnosed diabetes, 23.1% as having impaired glucose tolerance (IGT), and 0.8% as having impaired fasting glucose; and only 19.7% showed normal glucose levels. Another 47 patients (19.7%) had hyperglycemic values only in the 1st week (transient hyperglycemia) or could not be fully classified due to missing data in the oral glucose tolerance test. Patients with diabetes compared with nondiabetic subjects had more severe strokes (National Institutes of Health Stroke Scale [NIHSS] on admission: 7.2 +/- 6.6 vs. 4.6 +/- 3.1, 4.2 +/- 4.4, and 3.7 +/- 3.6 for IGT, transient hyperglycemia, and normoglycemia, respectively; P < 0.001), a worse outcome (modified Rankin scale 0-1 at discharge: 40.2 vs. 54.4, 63.8, and 72.3% for IGT, transient hyperglycemia, and normoglycemia, respectively; P < 0.001), and a higher rate of infectious complications (35.6 vs. 12.3, 21.2, and 4.2% for IGT, transient hyperglycemia, and normoglycemia, respectively; P < 0.001). In the multivariate analysis, NIHSS on admission, female sex, and the occurrence of urinary tract infection were independently associated with newly diagnosed diabetes.


CONCLUSIONS
The majority of acute stroke patients have disorders of glucose metabolism, and in most cases this fact has been unrecognized. Diabetes worsens the outcome of acute stroke. Therefore, in the post-acute phase, an oral glucose tolerance test should be recommended in all stroke patients with no prior history of diabetes.
Department of Neurology, Donauklinikum and Neurosciences Centre, Donau-Universität, Hauptstrasse 2, A-3400 Maria Gugging, Austria. karl.matz@donauklinikum.at
Karl
K
Matz
Katharina
K
Keresztes
Claudia
C
Tatschl
Monika
M
Nowotny
Alexandra
A
Dachenhausen
Alexandra
A
Dachenhausenm
Michael
M
Brainin
Jaakko
J
Tuomilehto
D000208:Acute Disease; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D005947:Glucose / Q000378:metabolism*; D044882:Glucose Metabolism Disorders / Q000150:complications* / Q000175:diagnosis; D005951:Glucose Tolerance Test; D006801:Humans; D006973:Hypertension / Q000150:complications; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000378:metabolism
D001786:Blood Glucose; D005947:Glucose