title: Diagnosed diabetes mellitus and in-hospital stroke mortality in a major sub-Saharan African urban medical unit.
abstract: Estimates from developed countries show that early mortality after stroke is unaffected by diabetes status. Despite the high burden of both conditions in sub-Saharan Africa, data on the association between diabetes status and early mortality are lacking.
  
  
  
  In a major referral hospital in the Capital city of Cameroon, among acute stroke patients diagnosed using the World Health Organization criteria, we compared mortality rates in patents with and without known diabetes.
  
  
  
  Stroke patients with and without known diabetes were compared for demographic characteristics, risk factors, clinical, radiological, laboratory characteristic, and in-hospital mortality. Heterogeneities in mortality rates across major subgroups were investigated via interaction tests, and logistic regression accelerated failure-time models used to adjust for confounders.
  
  
  
  Of the 1667 acute stroke patients included, 213 (12.8%) had diabetes mellitus. In general diabetic patients were older (median age 64.0 vs. 62.0 years, p=0.0006), and were more likely to have other stroke risk factors including a higher triglyceride levels on admission (106 vs. 97mg/dL, p=0.044), a history of stroke (19.7% vs. 13.6%, p=0.022), and a history of hypertension (89.7% vs. 64.8%, p<0.0001). The death rates of diabetic patients and that of non-diabetic patients were similar (22.1% vs. 20.1%. p=0.524). This finding was similar across all pre-specified groups, with no evidence of interaction. Diabetes was unrelated with mortality in adjusted regression models.
  
  
  
  Diabetes is frequent among stroke patients in this setting, and often co-exists with other stroke risk factors. In-hospital mortality rate is equally high in diabetic and non-diabetic patients.
authors.affiliation: Medical University of SC, Department of Neurology, Charleston, USA.
authors.forename: Alain
authors.initials: A
authors.lastname: Lekoubou
authors.affiliation: Faculty of Medicine and Biomedical Sciences, Department of Internal Medicine, Yaoundé, Cameroon.
authors.forename: Nkoke
authors.initials: N
authors.lastname: Clovis
authors.affiliation: Department of Internal Medicine, Douala General Hospital, Douala, Cameroon.
authors.forename: Anastase
authors.initials: A
authors.lastname: Dzudie
authors.affiliation: Department of Medicine, University of Cape Town, Cape Town, South Africa; South African Medical Research Council of South Africa, Cape Town, South Africa. Electronic address: andre.kengne@mrc.ac.za.
authors.forename: Andre Pascal
authors.initials: AP
authors.lastname: Kengne
mesh_terms: D000368:Aged; D002163:Cameroon / Q000453:epidemiology; D015897:Comorbidity; D003906:Developing Countries; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality*; D013997:Time Factors; D014504:Urban Health
keywords: Cameroon; Diabetes mellitus; Mortality; Sub-Saharan Africa; stroke