Diabetes and Poor Outcomes Within 6 Months After Acute Ischemic Stroke

Abstract

Background and Purpose-Diabetes mellitus (DM) is an independent risk factor for ischemic stroke. However, controversy exists with regard to the impact of DM on prognosis after ischemic stroke in the Chinese population. We investigated the associations between DM and death, dependency, and stroke recurrence in patients after ischemic stroke onset in a nationwide, prospective registry, the China National Stroke Registry. Methods-The China National Stroke Registry consecutively recruited patients hospitalized for acute ischemic stroke in 2007 to 2008 and who were prospectively followed up for clinical and functional outcomes (death, dependency, and stroke recurrence) at 3 and 6 months after disease onset. Multivariable logistic regression was performed to analyze the association between DM and stroke outcomes after adjusting for potential confounding including age, sex, National Institutes of Health Stroke Scale score, glucose level at admission, hypertension, coronary heart disease, smoking, urinary tract infection, and other factors. Results-DM was identified in 3483 (27.0%) of stroke patients. Compared with stroke patients without DM, patients with DM had a significantly higher incidence of death or dependency and of recurrent stroke at 3 and 6 months after stroke onset. DM was an independent risk factor for death or dependency (adjusted odds ratioϭ1.23; 95% confidence interval, 1.10 to 1.37) in patients with ischemic stroke at 6 months after onset. Conclusions-DM independently predicted poor outcomes in Chinese patients after acute ischemic stroke. (Stroke. 2011; 42:2758-2762.)

Association of Glomerular Filtration Rate With Outcomes of Acute Stroke in Type 2 Diabetic Patients: Results From the China National Stroke Registry

“…The increased risk of adverse poststroke outcomes with high or low eGFR might be partly explained by factors associated with decline of renal function, like anemia, oxidative stress, and inflammation, which could accelerate atherosclerosis and endothelial dysfunction (22). Our previous work has also indicated diabetes to be an independent predictor for adverse outcomes of acute stroke (23). The combination of diabetes and CKD might increase the risk of adverse stroke outcomes further.…”

Prognosis of Ischemic Stroke With Newly Diagnosed Diabetes Mellitus According to Hemoglobin A1c Criteria in Chinese Population

“…DM is an important risk factor for ischemic stroke; the reported hazard ratio (HR) for ischemic stroke was 2.3 (95% confidence interval [CI] 2.0-2.7) in individuals with DM versus those without DM. 1 Furthermore, ischemic stroke patients with DM have a poor prognosis, [2][3][4] and DM has been widely used to predict outcome after acute ischemic stroke or transient ischemic attack as an important risk factor. [5][6][7] The traditional glucose-based criteria of DM are based on a fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) (FPG ≥7.0 mmol/L and/or 2-hour OGTT ≥11.1 mmol/L).…”

Response to Letter by Zhang Regarding Article, “Diabetes and Poor Outcomes Within 6 Months After Acute Ischemic Stroke: The China National Stroke Registry”

“…1 We acknowledged that the patients diagnosed with diabetes mellitus (DM) in our study could have included a few patients with stress hyperglycemia according to the definition of DM adopted in this study ("a self-reported physician diagnosis of DM, use of hypoglycemic medications [for example, insulin or sulfonylureas] during hospitalization, or hypoglycemic medication use at discharge"). However, as Dr Zhang had mentioned in his letter, it was difficult to obtain the results of oral glucose tolerance tests from all the participating patients in such a multicenter, large-sample research as ours.…”