In a prospective study to analyse stroke topography and outcome in diabetics and to determine the prognostic value ofblood glucose and glycosylated haemoglobin estimation, we evaluated 176 patients with acute stroke. The patients were classified into four groups on the basis of history, fasting glucose, and glycosylated haemoglobin: euglycaemic patients with no history of diabetes, stress hyperglycaemia, newly diagnosed diabetics, and known diabetics. A high prevalence of undiagnosed diabetes was shown. No difference was found in the type or site of stroke between the four groups. No difference was found in the site of symptomatic or incidental lesions on computerised axial tomography. Patients with stress hyperglycaemia and known diabetics had more severe strokes. Mortality was higher in patients with stress hyperglycaemia, newly diagnosed diabetics, and the combined diabetes groups. This increased mortality was evident in the hyperglycaemic and diabetic groups, even after excluding patients with cerebral haemorrhage. Stroke severity and mortality also increased independently with blood glucose in the euglycaemic group. We conclude that there is a correlation between admission glucose concentration, diabetes, and poor stroke outcome, which may not be attributed to stroke type or location.Epidemiological and necropsy studies show that diabetic patients have a higher incidence of ischaemic stroke than non-diabetic patients.' 2 In the Framingham study the incidence of thrombotic stroke was 2-5 times higher in diabetic men and 3-6 times higher in diabetic women than in those without diabetes.3 Wolf and Kannell reported that even when other risk factors such as hypertension and ischaemic heart disease are taken into account diabetes remains an independent risk factor for stroke.4 Previous studies have found a range of prevalence of undiagnosed diabetes in acute stroke populations from 6%' to 42%6.The type and topography of diabetes-related cerebral infarction may differ from brain infarcts in non-diabetics. In a necropsy survey Kane and Aronson7 found that diabetics had more lacunar lesions when compared with non-diabetics, especially in the distribution of the parasagittal perforating arteries. Peress et al8 also reported a higher occurrence of lacunar infarcts in diabetics compared with non-diabetic patients. In the Harvard cooperative stroke registry,9 hypertension and diabetes were present respectively in 75% and 29% of lacunar cases and 71% and 43% of cases in the South Alabama population study.'o Several animal studies of experimental cerebral ischaemia have shown that hyperglycaemia increases the severity of ischaemic brain dam-

Aims/hypothesis: We compared the predictive performance of a GFR based on serum cystatin C levels with commonly used creatinine-based methods in subjects with diabetes.

No abstract

This study suggests that the clinical and biochemical parameters associated with serum cystatin C levels are closely linked to those associated with GFR and highlights the potential usefulness of screening for moderate or mild CKD in subjects with diabetes by simply measuring serum cystatin C levels.