Quality of Care and Outcomes in Patients With Diabetes Hospitalized With Ischemic Stroke

Reeves, Mathew J.; Vaidya, Robert S.; Fonarow, Gregg C.; Li, Liang; Smith, Eric E.; Matulonis, Robert; Olson, DaiWai M.; Schwamm, Lee H.

doi:10.1161/strokeaha.109.572693

Cited by 71 publications

(54 citation statements)

References 24 publications

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“…Our results are consistent with previous findings. 5,28 However, there has been a report in a Chinese population that showed that in-hospital mortality from ischemic stroke was not increased in patients with DM. 20 In our study, DM was significantly associated with death or dependency (mRSϭ3 to 6) in patients at 3 and 6 months after stroke onset, whereas the occurrence of coronary heart disease, pulmonary embolism, or peripheral artery disease showed comparable results between the 2 groups.…”

Section: Discussionmentioning

confidence: 99%

Diabetes and Poor Outcomes Within 6 Months After Acute Ischemic Stroke

Jia

Zhao

Wang

et al. 2011

Stroke

148

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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.)

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Section: Discussionmentioning

confidence: 99%

Diabetes and Poor Outcomes Within 6 Months After Acute Ischemic Stroke

Jia

Zhao

Wang

et al. 2011

Stroke

148

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“…Even though studies did not find overall reduced benefit of tPA in diabetic patients,12 decreased rates of tPA administrations are observed in diabetic patients 13. Guidelines recommend against tPA use in the 3‐ to 4.5‐hour window in patients with prior stroke plus diabetes based on insufficient evidence for its effectiveness, as patients with both prior stroke and diabetes were excluded from the European Cooperative Acute Stroke Study 3 trial 14.…”

Section: Introductionmentioning

confidence: 99%

Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post‐Thrombolysis: Findings From Get With The Guidelines‐Stroke

Masrur

Cox

Bhatt

et al. 2015

JAHA

Self Cite

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BackgroundHyperglycemia has been associated with adverse outcomes in patients with acute ischemic stroke (AIS) and may influence outcomes after tissue plasminogen activator (tPA). We sought to analyze the association of acute and chronic hyperglycemia on clinical outcomes in tPA‐treated patients.Methods and ResultsWe identified 58 265 AIS patients from 1408 sites who received tPA from 2009 to 2013 in Get With The Guidelines‐Stroke. Acute hyperglycemia at admission was defined as a plasma glucose level >140 mg/dL. Chronic hyperglycemia was defined by plasma glycosylated hemoglobin (HbA1c) >6.5%. Post‐tPA outcomes were analyzed using logistic regression. Blood glucose >140 mg/dL and HbA1c >6.5 were associated with worse clinical outcomes (symptomatic intracranial hemorrhage [sICH], life‐threatening hemorrhage, and in‐hospital mortality and length of stay) in diabetic and nondiabetic patients. Among patients with documented history of diabetes, increasing admission glucose up to 200 mg/dL was associated with increased adjusted odds ratio (aOR) of in‐hospital mortality (aOR, 1.07) and sICH (aOR, 1.05) per 10 mg/dL increase in blood glucose. Increasing HbA1C to 8% was associated with increased odds of in‐hospital mortality (aOR, 1.19) and sICH (aOR, 1.16) per 1% increase in HbA1c. Similar findings were observed in patients without a documented history of diabetes. There was no further increase in poor outcomes above the blood glucose level of 200 mg/dL or HbA1c >8.ConclusionAcute and chronic hyperglycemia are both associated with increased mortality and worse clinical outcomes in AIS patients treated with tPA. Controlled trials are needed to determine whether acute correction of hyperglycemia can improve outcomes after thrombolysis.

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“…This disease is associated with a polypathological condition, and its complications progressively affect quality of life and survival (Huang et al 2008;Eckert 2012). The many complications associated with diabetes include cardiovascular diseases, peripheral neuropathy, retinopathy, chronic renal failure, and impaired mental health (Blaum et al 2007;Maiorana et al 2002;Reeves et al 2010), which put diabetic patients in a polypathological condition (i.e., when diabetes coexists with two or more other diseases, such as hypertension, chronic renal failure, depression, and ischemic heart disease) (Rodríguez-Mañas et al 2014). In elderly populations, diabetes is also associated with reduced muscle strength, poor muscle quality, and accelerated loss of muscle mass (Morley 2008;Garg et al 2009;Leenders et al 2013;Park et al 2007;Volpato et al 2012;Morley et al 2014).…”

Section: Introductionmentioning

confidence: 99%

Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: improving functional status and quality of life

Cadore

Izquierdo

2015

AGE

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In elderly populations, diabetes is associated with reduced muscle strength, poor muscle quality, and accelerated loss of muscle mass. In addition, diabetes mellitus increases risk for accelerated aging and for the development of frailty syndrome. This disease is also associated with a polypathological condition, and its complications progressively affect quality of life and survival. Exercise interventions, including resistance training, represent the cornerstones of diabetes management, especially in patients at severe functional decline. This review manuscript aimed to describe the beneficial effects of different exercise interventions on the functional capacity of elderly diabetics, including those at polypathological condition. The SciELO, Science Citation Index, MEDLINE, Scopus, SPORTDiscus, and ScienceDirect databases were searched from 1980 to 2015 for articles published from original scientific investigations. In addition to the beneficial effects of exercise interventions on glycemic control, and on the cardiovascular risk factors associated with diabetes, physical exercise is an effective intervention to improve muscle strength, power output, and aerobic power and functional capacity in elderly diabetic patients. Thus, a combination of resistance and endurance training is the most effective exercise intervention to promote overall physical fitness in these patients. In addition, in diabetic patients with frailty and severe functional decline, a multicomponent exercise program including strength and power training, balance exercises, and gait retraining may be an effective intervention to reduce falls and improve functional capacity and quality of life in these patients.

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Quality of Care and Outcomes in Patients With Diabetes Hospitalized With Ischemic Stroke

Cited by 71 publications

References 24 publications

Diabetes and Poor Outcomes Within 6 Months After Acute Ischemic Stroke

Diabetes and Poor Outcomes Within 6 Months After Acute Ischemic Stroke

Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post‐Thrombolysis: Findings From Get With The Guidelines‐Stroke

Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: improving functional status and quality of life

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