Prevalence of Prediabetes and Newly Diagnosed Diabetes in Patients with a Transient Ischemic Attack or StrokeFonville S.a · Zandbergen A.A.M.b · Vermeer S.E.c · Dippel D.W.J.a · Koudstaal P.J.a · den Hertog H.M.a, d
aDepartment of Neurology, Erasmus Medical Center, and bDepartment of Internal Medicine, Ikazia Hospital, Rotterdam, cDepartment of Neurology, Rijnstate Hospital, Arnhem, and dDepartment of Neurology, Medical Spectrum Twente, Enschede, The Netherlands
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Background: Patients with a transient ischemic attack (TIA) or stroke and prediabetes or newly diagnosed diabetes are at high risk of recurrent stroke or cardiovascular events. This underlines the importance of accurate screening for impaired glucose metabolism in clinical practice. Fasting plasma glucose levels are currently the most commonly measured glycemic parameter to detect prediabetes or diabetes, even if 2-hour postload glucose and glycosylated hemoglobin levels can be used as well. We assessed the prevalence of prediabetes and newly diagnosed diabetes with different screening methods, including fasting plasma glucose, 2-hour postload glucose and glycosylated hemoglobin levels in consecutive patients with recent TIA, ischemic stroke or intracerebral hemorrhage admitted to the stroke unit or visiting the specialized TIA outpatient clinic in the Erasmus Medical Center, Rotterdam, The Netherlands. Methods: We measured fasting plasma glucose, 2-hour postload glucose and glycosylated hemoglobin levels in 269 patients with a TIA, 374 with ischemic stroke and 57 with intracerebral hemorrhage, all without a history of diabetes mellitus. Prediabetes was defined as fasting plasma glucose levels of 5.6-6.9 mmol/l and/or 2-hour postload glucose levels of 7.8-11.0 mmol/l and/or glycosylated hemoglobin levels of 5.7-6.4%. Newly diagnosed diabetes was defined as fasting plasma glucose levels of ≥7.0 mmol/l and/or 2-hour postload levels of ≥11.1 mmol/l and/or glycosylated hemoglobin levels of ≥6.5%. The diagnosis was based on a one-time measurement. Results: Based on fasting plasma glucose, 2-hour postload glucose and glycosylated hemoglobin levels combined, 365 patients (52%) were identified as prediabetics and 188 (27%) as having newly diagnosed diabetes. Patients with intracerebral hemorrhage had more often newly diagnosed diabetes compared with patients with an ischemic stroke or a TIA [27 (47%) and 161 (25%), respectively; p < 0.001]; the prevalence of prediabetes was similar. Newly diagnosed diabetes was identified more frequently by 2-hour postload glucose levels (n = 162; 23%) than by fasting plasma glucose (n = 49; 7%) or glycosylated hemoglobin levels (n = 36; 5%). About one third of the patients with normal fasting glucose levels has impaired glucose tolerance or elevated glycosylated hemoglobin levels. Conclusions: Prediabetes and newly diagnosed diabetes are highly prevalent in patients with a TIA or stroke. The majority of these patients would not have been identified by fasting plasma glucose levels alone. Both 2-hour postload glucose and glycosylated hemoglobin levels identify more patients with a disturbed glucose metabolism.
© 2013 S. Karger AG, Basel
- Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, Creager MA, Culebras A, Eckel RH, Hart RG, Hinchey JA, Howard VJ, Jauch EC, Levine SR, Meschia JF, Moore WS, Nixon JV, Pearson TA: Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42:517-584.
- Luitse MJ, Biessels GJ, Rutten GE, Kappelle LJ: Diabetes, hyperglycaemia, and acute ischaemic stroke. Lancet Neurol 2012;11:261-271.
- Buysschaert M, Bergman M: Definition of prediabetes. Med Clin North Am 2011;95:289-297, vii.
- American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care 2012;35(suppl 1):S64-S71.
- Ford ES, Zhao G, Li C: Pre-diabetes and the risk for cardiovascular disease: a systematic review of the evidence. J Am Coll Cardiol 2010;55:1310-1317.
- Lee M, Saver JL, Hong KS, Song S, Chang KH, Ovbiagele B: Effect of pre-diabetes on future risk of stroke: meta-analysis. BMJ 2012;344:e3564.
- Vermeer SE, Sandee W, Algra A, Koudstaal PJ, Kappelle LJ, Dippel DW: Impaired glucose tolerance increases stroke risk in nondiabetic patients with transient ischemic attack or minor ischemic stroke. Stroke 2006;37:1413-1417.
- Gray CS, Scott JF, French JM, Alberti KG, O'Connell JE: Prevalence and prediction of unrecognised diabetes mellitus and impaired glucose tolerance following acute stroke. Age Ageing 2004;33:71-77.
- Kernan WN, Viscoli CM, Inzucchi SE, Brass LM, Bravata DM, Shulman GI, McVeety JC: Prevalence of abnormal glucose tolerance following a transient ischemic attack or ischemic stroke. Arch Intern Med 2005;165:227-233.
- Vancheri F, Curcio M, Burgio A, Salvaggio S, Gruttadauria G, Lunetta MC, Dovico R, Alletto M: Impaired glucose metabolism in patients with acute stroke and no previous diagnosis of diabetes mellitus. QJM 2005;98:871-878.
- Matz K, Keresztes K, Tatschl C, Nowotny M, Dachenhausen A, Brainin M, Tuomilehto J: Disorders of glucose metabolism in acute stroke patients: an underrecognized problem. Diabetes Care 2006;29:792-797.
- Urabe T, Watada H, Okuma Y, Tanaka R, Ueno Y, Miyamoto N, Tanaka Y, Hattori N, Kawamori R: Prevalence of abnormal glucose metabolism and insulin resistance among subtypes of ischemic stroke in Japanese patients. Stroke 2009;40:1289-1295.
- Jia Q, Zheng H, Zhao X, Wang C, Liu G, Wang Y, Liu L, Li H, Zhong L, Wang Y: Abnormal glucose regulation in patients with acute stroke across China: prevalence and baseline patient characteristics. Stroke 2012;43:650-657.
- Dave JA, Engel ME, Freercks R, Peter J, May W, Badri M, van Niekerk L, Levitt NS: Abnormal glucose metabolism in non-diabetic patients presenting with an acute stroke: prospective study and systematic review. QJM 2010;103:495-503.
- Lindsberg PJ, Tuomi T, Kaste M: Oral glucose tolerance test should be performed after stroke and transient ischemic attack. Int J Stroke 2011;6:317-320.
- Ivey FM, Ryan AS, Hafer-Macko CE, Garrity BM, Sorkin JD, Goldberg AP, Macko RF: High prevalence of abnormal glucose metabolism and poor sensitivity of fasting plasma glucose in the chronic phase of stroke. Cerebrovasc Dis 2006;22:368-371.
- Lam KS, Ma JT, Woo E, Lam C, Yu YL: High prevalence of undiagnosed diabetes among Chinese patients with ischaemic stroke. Diabetes Res Clin Pract 1991;14:133-137.
- American Diabetes Association: Standards of medical care in diabetes: 2012. Diabetes Care 2012;35(suppl 1):S11-S63.
- Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, Halperin JL, Johnston SC, Katzan I, Kernan WN, Mitchell PH, Ovbiagele B, Palesch YY, Sacco RL, Schwamm LH, Wassertheil-Smoller S, Turan TN, Wentworth D: Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42:227-276.
- Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41.
Odderson IR: The National Institutes of Health Stroke Scale and its importance in acute stroke management. Phys Med Rehabil Clin N Am 1999;10:787-800, vii.
World Health Organization: Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO consultation. Geneva, World Health Organization, 1999.
- van den Herik EG, de Lau LM, Mohamad A, Ikram MA, Koudstaal PJ: Association of two single nucleotide polymorphisms from genomewide association studies with clinical phenotypes of cerebral ischemia. Int J Stroke 2012;7:219-223.
- Kruyt ND, Biessels GJ, Devries JH, Roos YB: Hyperglycemia in acute ischemic stroke: pathophysiology and clinical management. Nat Rev Neurol 2010;6:145-155.
- Hopper I, Billah B, Skiba M, Krum H: Prevention of diabetes and reduction in major cardiovascular events in studies of subjects with prediabetes: meta-analysis of randomised controlled clinical trials. Eur J Cardiovasc Prev Rehabil 2011;18:813-823.
- Gillies CL, Abrams KR, Lambert PC, Cooper NJ, Sutton AJ, Hsu RT, Khunti K: Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ 2007;334:299.
- Huisa BN, Roy G, Kawano J, Schrader R: Glycosylated hemoglobin for diagnosis of prediabetes in acute ischemic stroke patients. J Stroke Cerebrovasc Dis 2013; doi: pii:S1052-3057(13)00244-9.
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