Diabetes is common in patients with ischemic and/or hemorrhagic stroke, and a diabetes diagnosis with acute hyperglycemia may increase the risk for worse stroke outcomes, according to a study published in the Journal of Diabetes Investigation.
Researchers analyzed Ovid Medline and Embase databases to identify articles that described the prevalence of diabetes mellitus or acute hyperglycemia in stroke patients and the effects on mortality, neurologic recovery, rehabilitation outcomes, inpatient length of stay, readmission rates, and stroke recurrence. Included studies (n = 66) were published between January 1, 2004, and April 1, 2017.
The researchers performed a meta-analyses on 39 studies (n = 359,783 patients) assessing the prevalence of diabetes in stroke cohorts; diabetes was defined based on patient history, use of antidiabetic medications, or biochemical diagnostic methods. Further meta-analyses were performed on studies using glycated hemoglobin (HbA1c) as a diagnostic criterion for diabetes; thrombolysis studies were excluded from the meta-analyses.
The prevalence of diabetes in stroke inpatients was estimated at 28% (95% CI, 26%-31%); the prevalence was higher in patients with ischemic stroke (33%) compared with hemorrhagic stroke (26%), as well as in studies that included both stroke types (24%). The studies that used HbA1c alone to diagnose diabetes estimated prevalence in stroke patients at 37%. The prevalence of known diabetes and unknown diabetes ranged from 16% to 56.2% and 5% to 30.9%, respectively. In studies that used HbA1c and a history of diabetes to determine diabetes status, the prevalence of known diabetes was 27.7% to 56.2% in stroke patients.
A total of 6 studies found an association with diabetes and poor neurologic outcome; 4 studies did not demonstrate a difference. Most studies found a link between diabetes and longer in-hospital admission rates for stroke inpatients. Three studies found an association between hospital readmission and stroke recurrence at 3, 6, and 12 months. A total of 2 out of 7 studies found that increased mortality postdischarge and reduced survival were more common in patients with diabetes than without. Increasing HbA1c was found to be associated with worse outcomes for stroke, increased intensity of stroke, mortality rates, and stroke recurrence.
Lau L-H, Lew J, Borschmann K, Thijs V, Ekinci EI. The prevalence of diabetes and its effects on stroke outcomes; a meta-analysis and literature review [published online September 16, 2018]. J Diabetes Investig. doi: 10.1111/jdi.12932