Document Detail


Impaired glucose metabolism in patients with acute stroke and no previous diagnosis of diabetes mellitus.
MedLine Citation:
PMID:  16239309     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: About a third of patients with acute stroke and no prior diagnosis of diabetes have hyperglycaemia during the acute phase of stroke. Whether this is an acute stress response or a reflection of underlying diabetes is controversial. AIM: To assess whether impaired glucose metabolism in patients with acute ischaemic stroke and no previous diagnosis of diabetes persists after 3 months, and whether such persistence can be predicted. DESIGN: Prospective observational study. METHODS: We enrolled 106 patients with acute ischaemic stroke and no history of diabetes. Fasting blood glucose, serum insulin and the insulin resistance index HOMA were recorded during hospital stay. A standard oral glucose tolerance test was performed at discharge and 3 months later. RESULTS: Ten patients did not complete the study. Eighty-one patients (84.4%) had abnormal glucose metabolism at discharge and 62 (64.6%) after 3 months. Thirty-seven (38.5%) had impaired glucose tolerance at discharge and 26 (27.1%) after 3 months. Forty-four (45.8%) had diabetes at discharge, and 36 (37.5%) at 3 months. Post-load hyperglycaemia at discharge was a predictor of diabetes after 3 months. A plasma glucose cut-off of 11.7 mmol/l (210 mg/dl) had a specificity of 90.0% and a positive predictive value of 81.3%. HOMA increased progressively from patients with normal glucose metabolism to those with newly diagnosed diabetes. DISCUSSION: Impaired glucose tolerance and previously unrecognized diabetes could be detected early in the stroke course, and persisted after 3 months in more than two-thirds of our patients. Post-load hyperglycaemia during the acute phase of stroke may be useful in identifying patients with abnormal glucose metabolism, which places them at risk for adverse outcomes, including cardiovascular disease.
Authors:
F Vancheri; M Curcio; A Burgio; S Salvaggio; G Gruttadauria; M C Lunetta; R Dovico; M Alletto
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Publication Detail:
Type:  Journal Article     Date:  2005-10-20
Journal Detail:
Title:  QJM : monthly journal of the Association of Physicians     Volume:  98     ISSN:  1460-2725     ISO Abbreviation:  QJM     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-11-21     Completed Date:  2006-03-13     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9438285     Medline TA:  QJM     Country:  England    
Other Details:
Languages:  eng     Pagination:  871-8     Citation Subset:  IM    
Affiliation:
Unità Operativa di Medicina Interna, Ospedale S. Elia, Caltanisetta, Italy. fvanche@tin.it
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Diabetes Complications / epidemiology
Diabetes Mellitus / diagnosis,  metabolism*
Female
Glucose Intolerance / metabolism*
Glucose Tolerance Test
Hemoglobin A, Glycosylated / analysis
Humans
Italy / epidemiology
Male
Middle Aged
Prospective Studies
Regression Analysis
Stroke / metabolism*
Chemical
Reg. No./Substance:
0/Hemoglobin A, Glycosylated

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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