Abstract
ObjectivesTo 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.MethodsRetrospective 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.ResultsThe 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.ConclusionsHbA1c 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.
Highlights
Diabetes mellitus (DM) is a risk factor for stroke [1, 2] and is very common in acute ischemic stroke (IS) cases
There were no differences between both groups in age, sex, previous DM diagnoses (30.7% vs 30.3%), glucose at admission (121 mg/dl vs 129 mg/dl), vascular risk factors, stroke severity by National Institutes of Health Stroke Scale (NIHSS) (5 vs 6), Body mass index (BMI), and waist circumference (WC)
hemoglobin A1c (HbA1c) determination permits the exclusion of nondiabetic hyperglycemia as well as the identification of unknown DM patients admitted with normal glucose levels [12]
Summary
Diabetes mellitus (DM) is a risk factor for stroke [1, 2] and is very common in acute ischemic stroke (IS) cases. Unknown DM in acute IS could be over estimated by the high prevalence of poststroke hyperglycemia: approximately 40% of patients with acute IS have admission blood glucose.5130 mg/dL [11]. It is believed that the majority of such patients have DM or prediabetes, the possibility of poststroke-only hyperglycemia is possible in some cases [12]. Since 2010, the American Diabetes Association guidelines [13] have included HbA1c as a method to diagnose DM (HbA1c levels.56.5%) and prediabetes (HbA1c levels from 5.7% to 6.4%), but the impact of this recommendation at the time of hospitalization for stroke is unknown
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