Aims/Introduction
Diabetes mellitus is an established risk factor for
stroke and maybe associated with poorer outcomes after stroke. The aims
of the present literature review were to determine: (i) the prevalence
of diabetes in acute stroke patients through a meta‐analysis; (ii) the
association between diabetes and outcomes after ischemic and hemorrhagic
stroke; and (iii) to review the value of glycated hemoglobin and
admission glucose‐based tests in predicting stroke outcomes. (The aim should have been to write a protocol on this and get it distributed worldwide. You don't expect this to get much traction just by writing this, do you? Your responsibility did not end with this writeup, it just started.)
Materials and Methods
Ovid MEDLINE and EMBASE searches were carried out to
find studies relating to diabetes and inpatient stroke populations
published between January 2004 and April 2017. A meta‐analysis of the
prevalence of diabetes from included studies was undertaken. A narrative
review on the associations of diabetes and different diagnostic methods
on stroke outcomes was carried out.
Results
A total of 66 eligible articles met inclusion criteria. A meta‐analysis of 39 studies (n = 359,783)
estimated the prevalence of diabetes to be 28% (95% confidence interval
26–31). The rate was higher in ischemic (33%, 95% confidence interval
28–38) compared with hemorrhagic stroke (26%, 95% confidence interval
19–33) inpatients. Most, but not all, studies found that acute
hyperglycemia and diabetes were associated with poorer outcomes after
ischemic or hemorrhagic strokes: including higher mortality, poorer
neurological and functional outcomes, longer hospital stay, higher
readmission rates, and stroke recurrence. Diagnostic methods for
establishing diagnosis were heterogeneous between the reviewed studies.
Conclusions
Approximately one‐third of all stroke patients have
diabetes. 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.
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