Stroke, Vol 25, 1977-1984, Copyright © 1994 by American Heart Association
H Jorgensen, H Nakayama, HO Raaschou and TS Olsen
BACKGROUND AND PURPOSE: Although diabetes is a strong risk factor for
stroke, it is still unsettled whether stroke is different in patients with
and without diabetes. This is true for stroke type, stroke severity, the
prognosis, and the relation between admission glucose levels and stroke
severity/mortality. METHODS: This community-based study included 1135 acute
stroke patients (233 [20%] had diabetes). All patients were evaluated until
the end of rehabilitation by weekly assessment of neurological deficits
(Scandinavian Stroke Scale) and functional disabilities (Barthel Index). A
computed tomographic scan was performed in 83%. RESULTS: The diabetic
stroke patient was 3.2 years younger than the nondiabetic stroke patient (P
< .001) and had hypertension more frequently (48% versus 30%, P <
.0001). Intracerebral hemorrhages were six times less frequent in diabetic
patients (P = .002). Initial stroke severity, lesion size, and site were
comparable between the two groups. However, mortality was higher in
diabetic patients (24% versus 17%, P = .03), and diabetes independently
increased the relative death risk by 1.8 (95% confidence interval [CI],
1.04 to 3.19). Outcome was comparable in surviving patients with and
without diabetes, but patients with diabetes recovered more slowly.
Mortality increased with increasing glucose levels on admission in
nondiabetic patients independent of stroke severity (odds ratio, 1.2 per 1
mmol/L; CI, 1.01 to 1.42; P = .04). This was not the case in diabetic
patients. CONCLUSIONS: Diabetes influences stroke in several aspects: in
age, in subtype, in speed of recovery, and in mortality. Increased glucose
levels on admission independently increase mortality from stroke in
nondiabetic but not in diabetic patients. The effect of reducing high
admission glucose levels in nondiabetic stroke patients should be examined
in future trials.
ARTICLES
Stroke in patients with diabetes. The Copenhagen Stroke Study
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
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