title: Baseline diabetic status and admission blood glucose were poor prognostic factors in the EPITHET trial.
abstract: BACKGROUND
  Previous data have suggested that diabetes and hyperglycemia predict poor outcome following stroke. We studied the prognostic impact of diabetes and admission blood glucose in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET).
  
  
  METHODS
  EPITHET was a prospective randomized placebo-controlled trial of intravenous tissue plasminogen activator (tPA) in the 3- to 6-hour time window. A preexisting diagnosis of diabetes was noted and baseline serum glucose was measured.
  
  
  RESULTS
  Intravenous tPA attenuated infarct growth in non-diabetics, but not in diabetics (p = 0.029). In the tPA treatment group, admission blood glucose was higher among patients with poor functional outcome (p = 0.002).
  
  
  CONCLUSIONS
  Diabetes and hyperglycemia attenuate the effects of tPA on infarct evolution. Future thrombolytic trials should consider randomizing patients by subgroups based on diabetic status and serum glucose levels.
authors.affiliation: The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: D A
authors.initials: DA
authors.lastname: De Silva
authors.forename: M
authors.initials: M
authors.lastname: Ebinger
authors.forename: S
authors.initials: S
authors.lastname: Christensen
authors.forename: M W
authors.initials: MW
authors.lastname: Parsons
authors.forename: C
authors.initials: C
authors.lastname: Levi
authors.forename: K
authors.initials: K
authors.lastname: Butcher
authors.forename: P A
authors.initials: PA
authors.lastname: Barber
authors.forename: C
authors.initials: C
authors.lastname: Bladin
authors.forename: G A
authors.initials: GA
authors.lastname: Donnan
authors.forename: S M
authors.initials: SM
authors.lastname: Davis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis*; D004334:Drug Administration Schedule; D005060:Europe; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D007262:Infusions, Intravenous; D016014:Linear Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010343:Patient Admission; D018579:Patient Selection; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator