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(Stroke. 2004;35:e61.)
© 2004 American Heart Association, Inc.

Letters to the Editor

Association Between Diabetes and Stroke Subtype on Survival and Functional Outcome 3 Months After Stroke: Data From the European BIOMED Stroke Project

Department of Internal Medicine and Cardioangiology, University of Palermo, Palermo, Italy

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

Regarding the study by Megherbi et al¹ performed to evaluate stroke features, prognosis, and functional outcome in patients with diabetes compared with patients without diabetes, we would like to discuss some issues of potential interest:

First, the authors analyzed diabetic patients classified in accordance with WHO diagnostic criteria for diabetes used in 1993 (fasting plasma glucose >140 mg/dL), so it is probably an underestimation of the number of diabetic subjects in the 4537 consecutive patients with ischemic stroke enrolled. Perhaps if they could have classified diabetic patients in accordance with American Diabetes Association (1997)² criteria (fasting plasma glucose >126 mg/dL), a higher number of diabetic subjects would have been detected. Indeed the authors do not distinguish among known diabetes, newly diagnosed diabetes, and stress response hyperglycemia.

Second, in this study clinical subtypes of ischemic stroke were rated according to the Oxfordshire Community Stroke Project criteria, but it is conceivable that applying the TOAST classification³ of ischemic stroke—a classification with anatomical, physiopathological, clinical, and instrumental basis that is easily applicable and extensively validated—would offer a more precise selection of patients with lacunar strokes.

Third, Megherbi et al evaluated as outcome indicators vital status, handicap (Rankin score), and disability (Barthel index), but they have not evaluated acute neurological deficit using the Scandinavian Stroke Scale (SSS) so as to evaluate some difference between diabetic and nondiabetic subjects.

Fourth, our group (reference ⁴ and unpublished data), even in a case-control study of comparison between diabetic and nondiabetic including 102 diabetic patients and . . . [Full Text of this Article]

Salah-Eddine Megherbi, MD; Guy Victor Osseby, MD; Chantal Milan, PhD; Thibault Moreau, MD; Dominique Minier, MD; Grégory Couvreur, MD Maurice Giroud, MD

Stroke Registry of Dijon, Dijon, France

Charles Wolfe, MD Kate Tilling, MD

St Guy’s Hospital Health Department London, UK

Antonio Di Carlo, MD Domenico Inzitari, MD

Neurological Department, University Hospital, Firenze, Italy