Stroke. 48(Suppl_1):AWP376, FEB 2017
Issn Print: 0039-2499
Publication Date: 2017/02/01
Abstract WP376: Stress-Mediated Hyperglycemia or Undiagnosed Diabetes?
Mary Grove;Sharon Biby;Wendy Dusenbury;Abbigayle Doerr;Anne Lindstrom;Samuel Grove;Sandy Middleton;Anne Alexandrov;
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1Univ of Tennessee Health Science Cntr, Memphis, TN2Moses Cone Med Cntr, Greensboro, NC3UTHSC Mobile Stroke Unit and Wichita State Univ, Memphis, TN4Cadence Northwestern, Winfield, IL5Australian Catholic Univ, Sydney, Australia
Abstract
Background: “Stress mediated” hyperglycemia is often assumed to drive initial hyperglycemia during stroke admission. We sought to examine hemoglobin A1c (HbA1c) in relation to initial serum glucose.Methods: An observational design was used to examine glucose data from prospectively admitted acute stroke patients at 4 Comprehensive Stroke Centers. Data were entered and analyzed in SPSS using descriptive statistics, student t-tests, and Mann Whitney U.Results: 1226 patients were studied; 50% male, 63% White, 34% African American (AA); age averaged 69±13.5 years, and 93% were ischemic strokes. DM was known on admission in 37%. Admission HbA1c was 5.8±.7 in non-DM patients, compared to 7.8±1.8 in known DM patients (p<0.001; 95% CI=1.7-2.1). Patients with admission glucose >180mg/dL had significantly higher HbA1c (9.0±1.9) compared to lower glucose values (6.1±1.1, median 5.9; p<0.001; 95% CI=2.5-3.2). Importantly, of those with an admission glucose >180mg/dL, 94% met the diagnosis of DM by HbA1c, although 13% had not been previously diagnosed. Discharge mRS was significantly worse at a median of 4 (unable to walk independently) vs. 3 (p=0.001) in patients with admission glucose >180mg/dL, despite having equivalent median admission NIHSS of 3 in each group (p=NS).Conclusions: Admission glucose >180mg/dL should be recognized as a strong indicator of DM diagnosis and not be assumed to be stress mediated. Stroke nurses are encouraged to lead the early diagnosis/management of diabetes.
