Using routine HbA1c measurements in stroke and the associations of dysglycaemia with stroke outcomes

J Diabetes Complications. 2018 Nov;32(11):1056-1061. doi: 10.1016/j.jdiacomp.2018.08.013. Epub 2018 Aug 18.

Abstract

Aims: Diabetes is a major risk factor for stroke. We aimed to investigate the prevalence of diabetes and pre-diabetes within a stroke cohort and examine the association of glycaemia status with mortality and morbidity.

Methods: Inpatients aged ≥54 who presented with a diagnosis of stroke had a routine HbA1c measurement as part of the Austin Health Diabetes Discovery Initiative. Additional data were attained from hospital databases and Australian Stroke Clinical Registry. Outcomes included diabetes and pre-diabetes prevalence, length of stay, 6-month and in-hospital mortality, 28-day readmission rates, and 3-month modified Rankin scale score.

Results: Between July 2013 and December 2015, 610 patients were studied. Of these, 31% had diabetes while 40% had pre-diabetes. Using multivariable regression analyses, the presence of diabetes was associated with higher odds of 6-month mortality (OR = 1.90, p = 0.022) and higher expected length of stay (IRR = 1.29, p = 0.004). Similarly, a higher HbA1c was associated with higher odds of 6-month mortality (OR = 1.27, p = 0.005) and higher expected length of stay (IRR = 1.08, p = 0.010).

Conclusions: 71% of this cohort had diabetes or pre-diabetes. Presence of diabetes and higher HbA1c were associated with higher 6-month mortality and length of stay. Further research is necessary to determine if improved glycaemic control may improve stroke outcomes.

Keywords: Diabetes mellitus; Electronic Health Records; Hemoglobin A glycosylated; Prevalence; Stroke.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blood Glucose / analysis
  • Diabetes Complications / blood
  • Diabetes Complications / diagnosis
  • Diabetes Complications / epidemiology
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / epidemiology
  • Diagnostic Tests, Routine* / methods
  • Diagnostic Tests, Routine* / statistics & numerical data
  • Female
  • Glucose Metabolism Disorders / blood
  • Glucose Metabolism Disorders / complications
  • Glucose Metabolism Disorders / diagnosis*
  • Glucose Metabolism Disorders / epidemiology
  • Glycated Hemoglobin / analysis*
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Morbidity
  • Prediabetic State / blood
  • Prediabetic State / complications
  • Prediabetic State / diagnosis
  • Prediabetic State / epidemiology
  • Prevalence
  • Prognosis
  • Risk Factors
  • Stroke / blood*
  • Stroke / complications
  • Stroke / diagnosis*
  • Stroke / epidemiology

Substances

  • Blood Glucose
  • Glycated Hemoglobin A