Introduction: The increasing incidence of stroke in the developing countries has been attributed to the poor control of prevalent risk factors including diabetes. We aimed to evaluate the degree of glycemic control and its temporal changes in a cohort of stroke patients and whether these levels impacted patients outcomes.
Methods: This a longitudinal retrospective cohort of all stroke patients admitted to a single tertiary center between Jan 2010 to December 2014. Clinical, radiographic, and outcome data were collected. Admission and follow-up levels of Glycosylated Hemoglobin (HbA1c) were recorded. The WHO definitions of diabetics and pre-diabetics were used to define cases (Normal if HbA1c is less than 5.7%, Prediabetes 5.7% to 6.4% , Diabetes 6.5% or higher).
Results: A total of 548 patients were admitted during the study period. The mean age of the patients was 62.9 years (SD 16.9) and 42.1% were females. Saudi nationals represented 36.1% of all cases. Hemorrhagic stroke was diagnosed in 9.9%.
The admission HbA1c was checked in 332 (60.6%) patients. The mean level was 8.2% (Median 7.6%, range 4.9 to 15.1). Patients meeting the WHO definition of diabetes represented 16.3% while pre diabetics were 6.1%. At least one follow-up HbA1c reading was obtained in 101 patients who meet the WHO criteria for diabetes on stroke admission. Out of those, 30 patients (29.7%) had no change or worsening of the glycemic control with a mean increase in HbA1c of 1.1% compared to the stroke admission HbA1c (median increase of 0.9, range 3.9 to 0.1). The remaining 89 patients (70.3%) had better glycemic control with a mean drop of their HbA1c of 1.6% (median drop of 1.2, range 0.02 to 7.4).
Conclusion: Poor glycemic control was prevalent in patients admitted with stroke. Although the majority of patients had better glycemic control on subsequent follow-up, a third of tested patients had no change or worsening of their baseline HbA1c. This calls for the continued improvement of diabetes education and intervention clinics.