HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Erratum (v29,p1723) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager patientINFORMation Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Matz, K. Articles by Tuomilehto, J. Search for Related Content PubMed PubMed Citation Articles by Matz, K. Articles by Tuomilehto, J. Social Bookmarking                What's this?

Disorders of Glucose Metabolism in Acute Stroke Patients

An underrecognized problem

¹ Department of Neurology, Donauklinikum and Neurosciences Centre, Donau-Universität, Maria Gugging, Austria
² Department of Public Health, University of Helsinki, Helsinki, Finland

Address correspondence and reprint requests to Karl Matz, Department of Neurology, Donauklinikum and Neurosciences Centre, Donau-Universität, Hauptstrasse 2, A-3400 Maria Gugging, Austria. E-mail: karl.matz{at}donauklinikum.at

OBJECTIVE—To determine the prevalence of disturbances in glucose metabolism in patients with acute stroke.

RESEARCH DESIGN AND 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.

Abbreviations: IGT, impaired glucose tolerance • mRS, modified Rankin scale • NIHSS, National Institutes of Health Stroke Scale • OGTT, oral glucose tolerance test

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

Find additional patient-related information at:

Most Stroke Patients Have Problems With Glucose Metabolism

This article has been cited by other articles:

				R Peter, A Cox, and M Evans Management of diabetes in cardiovascular patients Heart, March 1, 2008; 94(3): 369 - 375. [Full Text] [PDF]

				A. Bruno, T. A. Kent, B. M. Coull, R. R. Shankar, C. Saha, K. J. Becker, B. M. Kissela, and L. S. Williams Treatment of Hyperglycemia In Ischemic Stroke (THIS): A Randomized Pilot Trial Stroke, February 1, 2008; 39(2): 384 - 389. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. V. d. Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J. Suppl., June 1, 2007; 9(suppl_C): C3 - C74. [Full Text] [PDF]

				Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. Van den Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J., January 1, 2007; 28(1): 88 - 136. [Full Text] [PDF]

				H.-F. Li, X.-D. Pan, N. Sanossian, and B. Ovbiagele Premorbid antiplatelet use and ischemic stroke outcomes. Neurology, November 14, 2006; 67(9): 1723 - 1723. [Full Text] [PDF]