title: Diabetes mellitus, admission glucose, and outcomes after stroke thrombolysis: a registry and systematic review.
abstract: OBJECTIVE
  The potential detrimental effect of diabetes mellitus and admission glucose level (AGL) on outcomes after stroke thrombolysis is unclear. We evaluated outcomes of patients treated by intravenous and/or intra-arterial therapy, according to diabetes mellitus and AGL.
  
  
  METHODS
  We analyzed data from a patient registry (n=704) and conducted a systematic review of previous observational studies. The primary study outcome was the percentage of patients who achieved a favorable outcome (modified Rankin score ≤2 at 3 months).
  
  
  RESULTS
  We identified 54 previous reports that evaluated the effect of diabetes mellitus or AGL on outcomes after thrombolysis. In an unadjusted meta-analysis that included our registry data and previous available observational data, diabetes mellitus was associated with less favorable outcome (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.73-0.79) and more symptomatic intracranial hemorrhage (OR, 1.38; 95% CI, 1.21-1.56). However, in multivariable analysis, diabetes mellitus remained associated with less favorable outcome (OR, 0.77; 95% CI, 0.69-0.87) but not with symptomatic intracranial hemorrhage (OR, 1.11; 95% CI, 0.83-1.48). In unadjusted and in adjusted meta-analysis, higher AGL was associated with less favorable outcome and more symptomatic intracranial hemorrhage; the adjusted OR (95% CI) per 1 mmol/L increase in AGL was 0.92 (0.90-0.94) for favorable outcome, and 1.09 (1.04-1.14) for symptomatic intracranial hemorrhage.
  
  
  CONCLUSIONS
  These results confirm that AGL and history of diabetes mellitus are associated with poor clinical outcome after thrombolysis. AGL may be a surrogate marker of brain infarction severity rather than a causal factor. However, randomized controlled evidences are needed to address the significance of a tight glucose control during thrombolysis on clinical outcome.
authors.affiliation: Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Desilles
authors.forename: Elena
authors.initials: E
authors.lastname: Meseguer
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lapergue
authors.forename: Gaia
authors.initials: G
authors.lastname: Sirimarco
authors.forename: Jaime
authors.initials: J
authors.lastname: Gonzalez-Valcarcel
authors.forename: Philippa
authors.initials: P
authors.lastname: Lavallée
authors.forename: Lucie
authors.initials: L
authors.lastname: Cabrejo
authors.forename: Celine
authors.initials: C
authors.lastname: Guidoux
authors.forename: Isabelle
authors.initials: I
authors.lastname: Klein
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
authors.forename: Mikael
authors.initials: M
authors.lastname: Mazighi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012042:Registries; D020521:Stroke / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose
keywords: acute stroke syndromes; diabetes mellitus; glucose; thrombolysis