Acute Stroke Patients with Newly Diagnosed Diabetes Mellitus Have Poorer Outcomes than Those with Previously Diagnosed Diabetes Mellitus

Mapoure, Njankouo Yacouba; Hamadou, Bâ; Ayeah, Chia Mark; Kenmegne, Caroline; Luma, Henry Namme; Njamnshi, Alfred K.

doi:10.1016/j.jstrokecerebrovasdis.2018.04.017

Cited by 15 publications

(16 citation statements)

References 35 publications

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“…Also, among the patients diagnosed with diabetes, nearly 25% were so-called unrecognized diabetes, newly diagnosed using HbA1C. Therefore, it has been recommended to check HbA1C or oral glucose tolerance test (OGTT) in all acute ischemic stroke patients, regardless of their previous history [21]. Among the recommended tests, HbA1C has an advantage over OGTT in identifying pre-diabetes in patients with acute stroke unaffected by the acute-phase reaction [6].…”

Section: Discussionmentioning

confidence: 99%

Pre-diabetes is a predictor of short-term poor outcomes after acute ischemic stroke using IV thrombolysis

Kim

Cha

2021

BMC Neurol

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Backgrounds Pre-diabetes is an intermediate state between normal glucose metabolism and diabetes. Recent studies suggest that the presence of pre-diabetes is associated with poor outcomes after AIS. However, the results have been controversial. This study examines whether pre-diabetes influences the patients’ short and long-term outcomes for AIS using IV thrombolysis. Methods We enrolled 661 AIS patients with IV thrombolysis. Based on the 2010 ADA guidelines, patients were classified as pre-diabetes, with HbA1c levels of 5.7–6.4%; diabetes, with HbA1c levels more than 6.5%; and NGM (normal glucose metabolism), with HbA1c levels less than 5.7%. We investigated short-term outcomes, including early neurologic deterioration (END), in-hospital death, and poor functional outcomes (mRS > 2) at 90 days. As for long-term outcomes, poor functional outcomes were measured at 1 year. Results Of the 661 AIS patients treated with IV thrombolysis, 197 patients (29.8%) were diagnosed with pre-diabetes, and 210 (31.8%) were diagnosed with diabetes. In a multivariate analysis, pre-diabetes was an independent predictor for END (OR = 2.02; 95% CI 1.12–3.62; p = 0.02) and in-hospital death (OR = 3.12; 95% CI 1.06–9.09; p = 0.04). On the other hand, diabetes was a significant independent factor for poor long-term outcomes (OR = 1.75; 95% CI 1.09–2.78; p = 0.02) after correcting confounding factors. Conclusions Unlike diabetes, pre-diabetes can be an important predictor of short-term outcomes after AIS. However, a more detailed research is needed to specify the precise mechanisms through which pre-diabetes affects the prognosis of acute ischemic stroke.

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Section: Discussionmentioning

confidence: 99%

Pre-diabetes is a predictor of short-term poor outcomes after acute ischemic stroke using IV thrombolysis

Kim

Cha

2021

BMC Neurol

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“…We know that several studies in non telestroke settings, reveal controversial findings on treatment outcomes for diabetic stroke patients that received thrombolysis therapy. While some studies report poorer outcomes in diabetic ischemic stroke patients when compared with non-diabetic acute ischemic stroke patients [2–4], others have shown the safety and beneficial effects of recombinant tissue plasminogen activator (rtPA) [5, 6]. It is also known that treatment outcomes in telestroke programs have been favorable, and consistent with good expectations in several studies in acute ischemic stroke [13–19].…”

Section: Introductionmentioning

confidence: 89%

The telestroke and thrombolysis therapy in diabetic stroke patients

Nathaniel

Ubah

Wormack

et al. 2019

Diabetol Metab Syndr

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Objective Several controversial findings have been reported on treatment outcomes for diabetic stroke patients that received thrombolysis therapy in the hospital. We determined whether the association between telestroke technology, thrombolysis therapy and clinical risk factors in diabetic acute ischemic stroke may result in the inclusion or exclusion or more diabetic ischemic stroke patients for thrombolysis therapy. Methods Retrospective data that comprises of a total of 3202 acute ischemic stroke patients from a regional stroke registry that contained telestroke and non telestroke patients with a primary diagnosis of acute ischemic stroke of which 312 were identified as diabetic stroke patients were used in this study. Multivariate logistic regression models were used to determine the associated pre-clinical risk factors, and demographics associated with recombinant tissue plasminogen activator (rtPA) therapy in a subset of diabetic acute ischemic stroke patients in the telestroke and non-telestroke settings. Results In the telestroke, only higher International Normalized Ratio (INR) [odds ratio, OR = 0.063 (0.003–1.347, 95% confidence interval (CI)] was associated with exclusion from thrombolysis. Direct admission [OR, 3.141 (1–9.867), 95% CI] and telestroke [OR, 4.87 (1.834–12.928), 95% CI] were independent predictors in the inclusion for thrombolysis therapy. In the non telestroke, older age (> 80 years) [(OR), 0.955 (0.922–0.989), 95% CI], higher blood glucose level [OR, 0.994 (0.99–0.999); 95% CI], higher INR [OR, 0.113 (0.014–0.944); 95% CI], and renal insufficiency [OR, 0.163 (0.033–0.791); 95% CI] were associated with exclusion while higher NIH stroke scale [OR, 1.068 (1.009–1.13); 95% CI] was associated with inclusion for thrombolysis in the non telestroke. Conclusion The non-telestroke setting admitted more diabetic stroke patients to the hospital, but more were excluded from thrombolysis therapy when compared with the telestroke setting. Measures to improve clinical risk factors that excluded more diabetic ischemic stroke patients in the non telestroke will improve the use of thrombolysis in the treatment of diabetic acute ischemic stroke patients.

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“…Also, among the patients diagnosed with diabetes, nearly 25% were so-called unrecognized diabetes, newly diagnosed by using HbA1C. Therefore, it has been recommended to check HbA1C or oral glucose tolerance test (OGTT) in all acute ischemic stroke patients, regardless of their previous history [17]. Among the recommended tests, HbA1C has an advantage over OGTT in identifying pre-diabetes in patients with an acute stroke unaffected by the acute-phase reaction [6].…”

Section: Discussionmentioning

confidence: 99%

Pre-Diabetes is a Predictor of Short-Term Poor Outcomes After Acute Ischemic Stroke Using iv Thrombolysis.: Pre-Diabetes Might Be an Alienated Area From Medical Attention Before Stroke Onset

Kim

Cha

2020

Preprint

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Backgrounds: Pre-diabetes is an intermediate state between normal glucose metabolism and diabetes. Recent studies suggest that the presence of pre-diabetes is associated with poor outcomes after AIS. However, the results have been controversial. This study examines whether pre-diabetes influences the patients' short and long-term outcomes for AIS using IV thrombolysis. Methods: We enrolled 661 AIS patients with IV thrombolysis. Based on the 2010 ADA guidelines, patients were classified as pre-diabetes, with HbA1c levels of 5.7%–6.4%; diabetes, HbA1c levels more than 6.5%; and NGM (normal glucose metabolism), with HbA1c levels less than 5.7%. We investigated short-term outcomes, including early neurologic deterioration (END), in-hospital death, and poor functional outcomes (mRS>2) at 90days. As for long-term outcomes, poor functional outcomes were measured at 1 year. Results: Of the 661 AIS patients treated with IV thrombolysis, 197 patients (29.8%) were diagnosed with pre-diabetes, and 210 (31.8%) were diagnosed with diabetes. In a multivariate analysis, pre-diabetes was an independent predictor for END (OR=2.02; 95% CI 1.12-3.62; p=0.02) and in-hospital death (OR=3.12; 95% CI 1.06-9.09; p=0.04). In contrast, diabetes was a significant independent factor for poor long-term outcomes (OR=1.75; 95% CI 1.09-2.78; p=0.02) after correcting confounding factors. Conclusion: Unlike diabetes, pre-diabetes can be an important predictor of short-term outcomes after AIS. However, more detailed research is needed to specify the precise mechanisms by which pre-diabetes affects the prognosis of acute ischemic stroke.

show abstract

Acute Stroke Patients with Newly Diagnosed Diabetes Mellitus Have Poorer Outcomes than Those with Previously Diagnosed Diabetes Mellitus

Cited by 15 publications

References 35 publications

Pre-diabetes is a predictor of short-term poor outcomes after acute ischemic stroke using IV thrombolysis

Pre-diabetes is a predictor of short-term poor outcomes after acute ischemic stroke using IV thrombolysis

The telestroke and thrombolysis therapy in diabetic stroke patients

Pre-Diabetes is a Predictor of Short-Term Poor Outcomes After Acute Ischemic Stroke Using iv Thrombolysis.: Pre-Diabetes Might Be an Alienated Area From Medical Attention Before Stroke Onset

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