Abstract
BackgroundDiabetes is an increasingly important risk factor for ischemic stroke and worsens stroke prognosis. Yet a large proportion of stroke patients who are eventually diabetic are undiagnosed. Therefore, it is important to have sensitive assessment of unrecognized hyperglycaemia in stroke patients.DesignSecondary outcome analysis of a randomized controlled trial focussing on parameters of glucose metabolism and detection of diabetes and prediabetes in patients with acute ischemic stroke (AIS).MethodsA total of 130 consecutively admitted patients with AIS without previously known type 2 diabetes mellitus (T2DM) were screened for diabetes or prediabetes as part of secondary outcome analysis of a randomized controlled trial that tested lifestyle intervention to prevent post-stroke cognitive decline. Patients had the oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) measurements in the second week after stroke onset and after 1 year. The detection rates of diabetes and prediabetes based on the OGTT or HbA1c values were compared.ResultsBy any of the applied tests at the second week after stroke onset 62 of 130 patients (48%) had prediabetes or T2DM. Seventy-five patients had results from both tests available, the OGTT and HbA1c; according to the OGTT 40 (53.3%) patients had normal glucose metabolism, 33 (44%) had prediabetes, two (2.7%) T2DM. In 50 (66.7%) patients the HbA1c results were normal, 24 (32%) in the prediabetic and one (1.3%) in the diabetic range. The detection rate for disorders of glucose metabolism was 10% higher (absolute difference; relative difference 29%) with the OGTT compared with HbA1c. After 1 year the detection rate for prediabetes or T2DM was 7% higher with the OGTT (26% relative difference).The study intervention led to a more favourable evolution of glycemic status after 1 year.ConclusionThe OGTT is a more sensitive screening tool than HbA1c for the detection of previously unrecognized glycemic disorders in patients with acute stroke with an at least a 25% relative difference in detection rate. Therefore, an OGTT should be performed in all patients with stroke with no history of diabetes. Trial registrationhttp://clinicaltrials.gov. Unique identifier: NCT01109836.
Highlights
Diabetes is an increasingly important risk factor for ischemic stroke and worsens stroke prognosis
The detection rate for disorders of glucose metabolism was 10% higher with the oral glucose tolerance test (OGTT) compared with Glycated haemoglobin (HbA1c)
The World Health Organisation (WHO) Consultation Group has agreed on the use of this HbA1c cut point but stressed that the OGTT should remain as the primary method to diagnose type 2 diabetes mellitus (T2DM) [8]
Summary
Diabetes is an increasingly important risk factor for ischemic stroke and worsens stroke prognosis. It is important to have sensitive assessment of unrecognized hyperglycaemia in stroke patients. Either diabetes type 2 (T2DM) or impaired glucose tolerance (IGT) are common in patients with stroke and impair their prognosis [1,2,3,4,5]. We have earlier shown that a high proportion of stroke patients with T2DM and all cases of IGT are undetected prior to the stroke event and would still remain undiscovered if fasting plasma glucose (FPG) alone is determined in the clinical evaluation of stroke patients [6]. As the recommended 2-h oral glucose tolerance test (OGTT) may be a time-consuming procedure, an International Expert Committee and the American Diabetes Association (ADA) have recommend the use of HbA1c as a diagnostic test [7] with ≥ 6.5% (48 mmol/mol) as the diagnostic cut-point for T2DM. With the HbA1c in the guidelines, the OGTT is used less in the routine clinical practice it is the only way to detect IGT as a postprandial dysregulation of blood glucose
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