Patients with diabetes have poorer stroke outcomes
Approximately one third of all stroke patients have diabetes, according to a large meta-analysis and literature review. Diabetes is associated with poorer stroke outcomes compared with people without diabetes
Two reviewers carried out a literature search using both Ovid Medline and Ovid Embase databases to include articles published in English between 1 January 2004 and 1 April 2017. Total of 2242 articles were identified during the literature search and 66 eligible articles met the inclusion criteria.
A meta‐analysis of 39 studies (n = 359,783) estimated the prevalence of diabetes to be 28% (95% CI 26–31). The rate was higher in ischaemic (33%, 95% CI 28–38) compared with haemorrhagic stroke (26%, 95% CI 19–33) inpatients. Most, but not all, studies found that acute hyperglycaemia and diabetes were associated with poorer outcomes after ischaemic or haemorrhagic strokes: including higher mortality, poorer neurological and functional outcomes, longer hospital stay, higher readmission rates, and stroke recurrence. A meta‐analysis of studies using HbA1c alone to diagnose diabetes estimated the prevalence of diabetes in all stroke types to be 37% (95% CI 27–47).
The authors commented on the heterogeneity in the methods used in the studies to diagnose diabetes. As the burden of diabetes rises, stroke as a major complication of diabetes is expected to rise. More efficient and accurate ways of screening for diabetes are required to minimize the progressive burden this will have on the global healthcare system. Whether tight control of diabetes or acute hyperglycaemia after stroke is beneficial remains an important question.
These studies highlight the importance of detecting hyperglycaemia post‐stroke and recognizing the potential for poorer outcomes.
Lau L-H et al. Prevalence of diabetes and its effects on stroke outcomes: A meta-analysis and literature review. Journal of Diabetes Investigation 2018 https://www.onlinelibrary.wiley.com/doi/full/10.1111/jdi.12932
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