Public health

High diabetes rates in stroke patients suggest need for screening


A third of stroke patients have diabetes and screening for it could help address the poor outcomes in stroke associated with dysglycaemia, Victorian researchers say.

A meta-analysis of 39 studies involving almost 360,000 patients with acute stroke has estimated the prevalence of diabetes to be 28% overall and 33% in patients with ischaemic stroke.

The literature review, co-authored by researchers in the Department of Neurology, Austin Health, also showed that acute ‘stress’ hyperglycaemia is associated with poor outcomes after stroke, including poorer neurological and functional measures, longer hospital stay, higher readmission rates and stroke recurrence rates.

However there was some heterogeneity in results for long term diabetes and some stroke outcomes such as mortality, according to the authors of the review published in the Journal of Diabetes Investigation.

Since traditional blood glucose measures such as fasting blood  glucose are independent predictors of stroke outcomes, there may be a screening role for these in acute stroke patients, the researchers suggested.

And since the review also showed high rates of undiagnosed diabetes among stroke patients there would also be a role for HbA1c measures as part of a screening approach in stroke patients, they argue.

“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 needed to minimise the progressive burden this will have on the global healthcare system,” they write.

“Whether tight control of diabetes or acute hyperglycaemia after stroke is beneficial is not within the scope of this review and remains an important question.”

“Uniform methods to screen for diabetes after stroke are required to identify individuals with diabetes to design interventions aimed at reducing poor outcomes in this high risk population,” they conclude.

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