title: The role of HbA1c determination in detecting unknown glucose disturbances in ischemic stroke.
abstract: OBJECTIVE
  To evaluate the usefulness of hemoglobin A1c (HbA1c) determinations during the acute ischemic stroke (IS) to identify undiagnosed glucose disturbances in a prospective series of patients with first-ever IS.
  
  
  METHODS
  Retrospective analysis of a prospective series of first-ever IS patients. Patients with previous diagnosis of diabetes mellitus (DM) were excluded from the study. Patients were classified as non-DM (HbA1c<5.7% and no previous evidence of 2 or more fasting blood glucose> = 126 mg/dL), prediabetes (HbA1c from 5.7% to 6.4%), and new suspected DM (HbA1c> = 6.5% independently of current blood glucose). Medical charts from hospital discharge to July 2014 of all suspected DM patients were reviewed to confirm the DM diagnosis.
  
  
  RESULTS
  The initial cohort included 1283 patients, of which 393 were excluded because of previous DM diagnosis and 136 because HbA1c during acute stroke phase was not available. No demographic differences were observed between patients with and without HbA1c determinations. The final cohort was composed of 754 patients with first-ever IS and unknown DM history. HbA1c determination suggested new DM in 87 cases (11.5%) and detected 273 patients with prediabetes (36.2%). New DM cases were identified in all etiological stroke subtypes. After discharge, DM diagnosis was confirmed in 80.2% of patients with available follow-up.
  
  
  CONCLUSIONS
  HbA1c determination detected both undiagnosed DM and prediabetes in IS patients without taking into account the blood glucose values during admission, and independently of etiological stroke subtype. HbA1c determination should be included in the systematic screening of all IS patients.
authors.affiliation: Servei de Neurologia, IMIM-Hospital del Mar, DCEXS, Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Roquer
authors.affiliation: Servei de Neurologia, IMIM-Hospital del Mar, Department de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-Campello
authors.affiliation: Servei de Neurologia, IMIM-Hospital del Mar, DCEXS, Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: Cuadrado-Godia
authors.affiliation: Servei de Neurologia, IMIM-Hospital del Mar, Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Giralt-Steinhauer
authors.affiliation: Servei de Neurologia, IMIM-Hospital del Mar, Department de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Jiménez-Conde
authors.affiliation: Servei de Neurologia, IMIM-Hospital del Mar, Barcelona, Spain.
authors.forename: Carol
authors.initials: C
authors.lastname: Soriano
authors.affiliation: Servei de Neurologia, IMIM-Hospital del Mar, Department de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Ois
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000097:blood / Q000453:epidemiology / Q000378:metabolism*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000378:metabolism; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain
chemical_list: D005947:Glucose; D006442:Glycated Hemoglobin