Abstract WP209: Pre-morbid Glycemic Control in Patients With Type II Diabetes Does not Modify Short-term Outcome in Acute Ischemic Stroke

Abstract

Background: The presence of pre-morbid diabetes is a predictor of worse outcome following acute ischemic stroke (AIS). Hyperglycemia on admission is also associated with more severe strokes and poorer outcomes in patients with or without established diabetes. We aimed to examine the relationship between pre-morbid diabetes management and outcome following AIS. Methods: Patients who presented to our center with AIS between 07/2008-07/2014 were included if pertinent past medical history and admission laboratory values of HbA1C were obtained at admission. Logistic regression was used to assess differences in baseline, in-hospital, and outcome variables in patients with well-controlled diabetes (DM+/C+) and poorly controlled diabetes (DM+/C-) as compared to those with no diabetes (DM-). Well-controlled diabetes was defined as an admission laboratory value of HbA1C < 7% in a patient with diabetes per history. The primary outcome measure was poor functional outcome (modified Rankin Scale > 2) on discharge. Results: A total of 1,375 cases were analyzed; 924 patients (67.2%) in the DM- group, 260 patients (18.9%) in the DM+/C- group, and 191 patients (13.9%) in the DM+/C+ group. After adjustment for age, NIHSS score at baseline, and tPA administration, DM- patients were significantly less likely to experience poor functional outcome compared to DM+/C+ patients (OR=0.70, 95% CI 0.48-1.04, p=0.0025). No significant difference was observed between the DM+/C- and DM+/C+ groups with respect to poor functional outcome (OR=0.86, 95% CI 0.58-1.26, p=0.5720). Conclusions: The absence of diabetes in the setting of AIS is associated with less likelihood of poor functional outcome. However, patients with well-controlled diabetes did not differ in functional outcome following ischemic stroke compared to those with poorly controlled diabetes, suggesting that the diagnosis of diabetes itself has clinical relevance to early outcome after ischemic stroke, regardless of the level of control at stroke onset.