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The Influence of Hyperglycemia and Diabetes Mellitus on Immediate and 3-Month Morbidity and Mortality After Acute Stroke

The Influence of Hyperglycemia and Diabetes Mellitus on Immediate and 3-Month Morbidity and... Abstract • Fasting serum glucose, glycosylated hemoglobin, and fructosamine concentrations were determined in 304 consecutive subjects admitted with acute stroke, within 48 hours of ictus. Based on the medical history and these results, subjects were divided into known diabetics, newly diagnosed diabetics, subjects with stress hyperglycemia, and nondiabetics. The type of stroke was classified as lacunar infarct, cerebral infarct, or intracerebral hemorrhage, based on clinical examination by a neurologist and computed tomographic brain scan and/or autopsy. Immediate and 3-month outcomes were examined in relation to (1) fasting glucose, glycosylated hemoglobin, and fructosamine levels by stroke subtypes, and (2) glucose tolerance categories by stroke subtypes. A high fasting glucose level was associated with an increased mortality, but this was observed only among patients with intracerebral hemorrhage. Patients with stress hyperglycemia, but not diabetics, had increased mortality. In spite of having similar glucose concentrations to those patients with stress hyperglycemia, diabetics did not have a worse outcome compared with nondiabetics. It is concluded that the association between glucose concentration and outcome is a reflection of stress relating to stroke severity, rather than a direct harmful effect of glucose on damaged neurons. References 1. Pulsinelli WA, Waldman S, Rawlinson D, Plum F. Moderate hyperglycemia augments ischemie brain damage: a neuropathological study in the rat . Neurology . 1982;32:1239-1246.Crossref 2. Pulsinelli WA, Levy DE, Sigsbee B, Scherer P, Plum F. Increased damage after ischemic stroke in patients with hyperglycemia with or without established diabetes mellitus . Am J Med . 1983;74:540-544.Crossref 3. Oppenheimer SM, Hoffbrand BI, Oswald GA, Yudkin JS. Diabetes mellitus and early mortality from stroke . BMJ . 1985;291:1014-1015.Crossref 4. Woo E, Chan YW, Yu YL, Huang CY. Admission glucose level in relation to mortality and morbidity outcome in 252 stroke patients . Stroke . 1988;19:185-191.Crossref 5. Power MJ, Fullerton KJ, Stout RJ. Blood glucose and prognosis of acute stroke . Age Ageing . 1988;17:164-170.Crossref 6. Bamford J, Sandercock P, Jones L, Warlow C. The natural history of lacunar infarction: the Oxfordshire Community Stroke Project . Stroke . 1987;18:545-551.Crossref 7. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index . Md State Med J . 1965;14:61-65. 8. Hodkinson HM. Evaluation of a mental test score for assessment of mental impairment in the elderly . Age Ageing . 1972;1:233-238.Crossref 9. Woo J, Swaminathan R, Cockram R, et al. The prevalence of diabetes mellitus and an assessment of methods of detection among a community of elderly Chinese in Hong Kong . Diabetologia . 1987;30:863-868. 10. Johnson RN, Metcalf PA, Baker JR. Fructosamine: a new approach to the estimation of serum glycosylprotein: an index of diabetic control . Clin Chim Acta . 1982;127:87-95.Crossref 11. Kiers L, Davis SM, Larkins RG, et al. Pathogenesis and outcome of stroke in diabetes and hyperglycemia . Stroke . 1989;20:9. 12. Storm T, Hildebrandt P, Sykulski R. Diabetes mellitus and early mortality from stroke . BMJ . 1985;291:1577.Crossref 13. Bennet PH. Diabetes in the elderly: diagnosis and epidemiology . Geriatrics . 1984;39:37-41. 14. Myers M, Norris JW, Hachinski VC, Sole MJ. Plasma norepinephrine in stroke . Stroke . 1981;12:200-204.Crossref 15. World Health Organization. Diabetes Mellitus . Geneva, Switzerland: World Health Organization; 1985:103-108. World Health Organization Technical Series No. 722. 16. Kunitz SC, Gross CR, Heyman A, et al. The pilot stroke data bank: definition, design, and data . Stroke . 1984;15:740-746.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

The Influence of Hyperglycemia and Diabetes Mellitus on Immediate and 3-Month Morbidity and Mortality After Acute Stroke

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References (19)

Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1990.00530110028011
Publisher site
See Article on Publisher Site

Abstract

Abstract • Fasting serum glucose, glycosylated hemoglobin, and fructosamine concentrations were determined in 304 consecutive subjects admitted with acute stroke, within 48 hours of ictus. Based on the medical history and these results, subjects were divided into known diabetics, newly diagnosed diabetics, subjects with stress hyperglycemia, and nondiabetics. The type of stroke was classified as lacunar infarct, cerebral infarct, or intracerebral hemorrhage, based on clinical examination by a neurologist and computed tomographic brain scan and/or autopsy. Immediate and 3-month outcomes were examined in relation to (1) fasting glucose, glycosylated hemoglobin, and fructosamine levels by stroke subtypes, and (2) glucose tolerance categories by stroke subtypes. A high fasting glucose level was associated with an increased mortality, but this was observed only among patients with intracerebral hemorrhage. Patients with stress hyperglycemia, but not diabetics, had increased mortality. In spite of having similar glucose concentrations to those patients with stress hyperglycemia, diabetics did not have a worse outcome compared with nondiabetics. It is concluded that the association between glucose concentration and outcome is a reflection of stress relating to stroke severity, rather than a direct harmful effect of glucose on damaged neurons. References 1. Pulsinelli WA, Waldman S, Rawlinson D, Plum F. Moderate hyperglycemia augments ischemie brain damage: a neuropathological study in the rat . Neurology . 1982;32:1239-1246.Crossref 2. Pulsinelli WA, Levy DE, Sigsbee B, Scherer P, Plum F. Increased damage after ischemic stroke in patients with hyperglycemia with or without established diabetes mellitus . Am J Med . 1983;74:540-544.Crossref 3. Oppenheimer SM, Hoffbrand BI, Oswald GA, Yudkin JS. Diabetes mellitus and early mortality from stroke . BMJ . 1985;291:1014-1015.Crossref 4. Woo E, Chan YW, Yu YL, Huang CY. Admission glucose level in relation to mortality and morbidity outcome in 252 stroke patients . Stroke . 1988;19:185-191.Crossref 5. Power MJ, Fullerton KJ, Stout RJ. Blood glucose and prognosis of acute stroke . Age Ageing . 1988;17:164-170.Crossref 6. Bamford J, Sandercock P, Jones L, Warlow C. The natural history of lacunar infarction: the Oxfordshire Community Stroke Project . Stroke . 1987;18:545-551.Crossref 7. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index . Md State Med J . 1965;14:61-65. 8. Hodkinson HM. Evaluation of a mental test score for assessment of mental impairment in the elderly . Age Ageing . 1972;1:233-238.Crossref 9. Woo J, Swaminathan R, Cockram R, et al. The prevalence of diabetes mellitus and an assessment of methods of detection among a community of elderly Chinese in Hong Kong . Diabetologia . 1987;30:863-868. 10. Johnson RN, Metcalf PA, Baker JR. Fructosamine: a new approach to the estimation of serum glycosylprotein: an index of diabetic control . Clin Chim Acta . 1982;127:87-95.Crossref 11. Kiers L, Davis SM, Larkins RG, et al. Pathogenesis and outcome of stroke in diabetes and hyperglycemia . Stroke . 1989;20:9. 12. Storm T, Hildebrandt P, Sykulski R. Diabetes mellitus and early mortality from stroke . BMJ . 1985;291:1577.Crossref 13. Bennet PH. Diabetes in the elderly: diagnosis and epidemiology . Geriatrics . 1984;39:37-41. 14. Myers M, Norris JW, Hachinski VC, Sole MJ. Plasma norepinephrine in stroke . Stroke . 1981;12:200-204.Crossref 15. World Health Organization. Diabetes Mellitus . Geneva, Switzerland: World Health Organization; 1985:103-108. World Health Organization Technical Series No. 722. 16. Kunitz SC, Gross CR, Heyman A, et al. The pilot stroke data bank: definition, design, and data . Stroke . 1984;15:740-746.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Nov 1, 1990

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