Impaired glucose tolerance after acute stroke

ABSTRACT

The objective of this work is to determine the prevalence of disturbances in glucose metabolism in patients with acute stroke. Research design and methods-Consecutively admitted acute stroke patient [n=100] were screened for glucose tolerance according to the standardized World Health Organization protocol in the 1[st] and 2[nd] week after the stroke event. In addition, we repeatedly measured fasting capillary blood glucose during the first 10 days. Of the 100 subjects analyzed, 30 [30%] were classified as having newly diagnosed diabetes, 28 [28%] as having IGF or IGT, 29 [29%] as having transient hyperglycemia and only 16 [16%] were normoglycemia. Patients with newly diagnosed diabetes had more severe stroke National Institutes of Health Stroke Scale [NIHSS] on admission], hypertension and HbAIc than other studied groups [p<0.001], a higher rate of pneumonia and urinary tract infection during the admission [P0.001] and a worse outcome at discharge [mRS 0-1 at discharge]; [P<0.001] than nondiabetic patients. Patients with normal glucose regulation were more often men [more women among diabetic patients] and significantly younger than patients classified as having abnormal glucose regulation. In multivariate logistic regression model, National Institutes of Health Stroke Scale [NIHSS] on admission, female sex and urinary tract infection were independently associated with the classification of newly diagnosed diabetes. Age < 70 years and normotension were factors associated with normal glucose values in OGTT. It could be concluded that - The majority of acute stroke patients have disorders of glucose metabolism and in most cases this fact has been unrecognized. Diabetes worsens the outcome of acute stroke. Therefore, in the post-acute phase, an oral glucose tolerance test should be recommended in all stoke patients with no prior history of diabetes