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Hyperglycemia in ischemic stroke patients

The aim of the study was to determine the possible association between the duration of diabetes mellitus and prevalence of ischemic stroke. Also, the effect of hyperglycemia in the acute phase of ischemic stroke on the short-term outcome of stroke was studied. Study group consisted of 429 patients hospitalized at our department for ischemic stroke during 12 consecutive months. The diagnosis and type of diabetes were established on the basis of pre-stroke history data and confirmed by consultant diabetologist (glucose levels monitoring by repeated blood tests). The diagnosis and outcome of brain infarction were assessed on the basis of clinical and neuroimaging criteria. Hyperglycemia was recorded in 95 patients with ischemic stroke (22.1% of all cases); 72 of them had the diagnosis of diabetes mellitus established prior to stroke (type 1 in nine, and type 2 in 63 patients)., There were 53 females and 42 males, mean age 68.6+/-7.8 years . Hypertension was an additional risk factor for stroke in 87.4%, while elevated blood cholesterol was found in only 31.1% of patients. Brain imaging showed territorial infarction in 46 cases of ischemic stroke, followed by 21 cases of lacunar infarction, and hemodynamic stroke in two cases. Diabetes of 6 or more years was associated with a higher rate of ischemic stroke than the shorter diabetes duration of up to 5 years (50 vs. 22 patients). Further analysis revealed a significant difference in stroke prevalence between the patients with type 2 diabetes duration of 6 -10 years and 11 and more years (p<0.01); in the group of patients with longest diabetes duration , the presence of this disease facilitated the occurrence of stroke . The functional outcome of stroke as assessed by the Modified Rankin Scale showed a more severe functional deficit in the group of patients with hyperglycemia (Rankin 0 and 1 in 7.4%, Rankin 2 and 3 in 28.7%, Rankin 4 and 5 in 35.2% of all cases) than in the group of ischemic stroke patients without hyperglycemia (Rankin 0 and 1 in 24.2%, Rankin 2 and 3 in 27.4%, Rankin 4 and 5 in 26.2% of all cases). The case fatality rate was higher in the former than in the latter group ( 28.7% vs 22.2% of all cases). Diabetes was found to be an important risk factor for ischemic stroke. Prolonged duration of diabetes had greater impact on the occurrence of stroke than shorter duration of the disease. The presence of hyperglycemia in the acute phase of stroke aggravates the final outcome of ischemic stroke. Thus, early detection and management of hyperglycemia should be considered important measures for the prevention of stroke.

brain ischemia; complications; hyperglycemia; diabetes mellitus; complications; diabetes mellitus; epidemiology

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