Stroke in diabetic and non‐diabetic patients: Course and prognostic value of admission serum glucose

Figures & data

Table I. Baseline characteristics of 992 diabetic and non‐diabetic patients with acute stroke

	Non‐diabetic patients, n = 696	Diabetic patients, n = 296	P value
Demography
Age years^a	77 (69–83)	76 (68–82)	0.3539
Female n (%)	392 (56)	175 (59)	0.4148
Current smoking n (%)	64 (9)	25 (8)	0.7054
Duration of hospitalization days^a	13 (9–20)	14 (9–22)	0.0459
Body Mass Index^a	25.7 (23–28)	26.4 (24–29)	0.0105
Type and location of stroke
Ischemic stroke n (%)	546 (78)	259 (88)	0.0009
Intracerebral hemorrhage n (%)	89 (13)	14 (5)	0.0001
Lacunar stroke n (%)	55 (8)	20 (7)	0.5323
Hemispheric stroke n (%)	304 (44)	136 (46)	0.5106
Cerebellar stroke n (%)	28 (4)	20 (7)	0.0663
Brainstem stroke n (%)	67 (10)	28 (10)	0.9348
Neurological scores
Barthel Index^a	35 (5–75)	25 (5–65)	0.1300
Rankin scale^a	4 (2–5)	4 (3–5)	0.0065
Comatose patients n (%)	84 (12)	28 (10)	0.2959
NIHSS (non‐comatose patients) ^a	6 (3–13)	7 (4–14)	0.2024
Findings on admission
Systolic blood pressure mmHg^a	160 (140–180)	162 (140–190)	0.1131
Diastolic blood pressure mmHg^a	90 (80–100)	85 (80–100)	0.3821
Heart rate beats/min^a	80 (70–94)	82 (72–97)	0.0377
Serum glucose mmol/L^a	6.3 (5.4–7.8)	10.0 (7.5–13.8)	<0.0001
Hemoglobin g/L^a	140 (130–150)	138 (130–150)	0.2111
Cholesterol mmol/L^a	5.5 (4.7–6.4)	5.6 (4.6–6.5)	0.8249
Creatinine micromol/L^a	88.4 (75.1–106.1)	88.4 (79.6–127.3)	0.3673
Fibrinogen g/L^a	3.71 (3.20–4.50)	3.89 (3.20–4.64)	0.2599
Co‐morbidities
Atrial fibrillation/flutter n (%)	210 (30)	94 (32)	0.6204
Coronary heart disease n (%)	168 (24)	105 (35)	0.0003
Hypertension n (%)	458 (66)	221 (75)	0.0060
Previous stroke n (%)	183 (26)	98 (33)	0.0292
Other heart disease n (%)	121 (17)	52 (18)	0.9447
Obstructive pulmonary disease n (%)	40 (6)	14 (5)	0.5181
Dementia n (%)	57 (8)	32 (11)	0.1862
Malignancy n (%)	32 (5)	14 (5)	0.9279

^a median (inter‐quartile range)

Table II. Complications in diabetic and non‐diabetic patients with acute stroke

	Non‐diabetic patients, n = 696	Diabetic patients, n = 296	P value
Stroke‐related neurological complications
Cerebral edema n (%)	83 (12)	30 (10)	0.4167
Hydrocephalus n (%)	3 (0.4)	0	0.2579
Recurrent stroke n (%)	19 (3)	15 (5)	0.0640
Epileptic seizure n (%)	19 (3)	6 (2)	0.5181
Symptomatic intracerebral bleeding n (%)	26 (4)	10 (3)	0.7830
Any neurological complication n (%)	125 (18)	55 (19)	0.8162
Medical complications
Pneumonia n (%)	96 (14)	39 (13)	0.7952
Urinary tract infection n (%)	85 (12)	57 (19)	0.0037
Sepsis n (%)	9 (1)	3 (1)	0.7124
Deep venous thrombosis n (%)	6 (1)	1 (0.3)	0.3667
Pulmonary embolism n (%)	5 (1)	4 (1)	0.3360
Pulmonary edema n (%)	49 (7)	26 (9)	0.3418
Extracerebral bleeding n (%)	2 (0.3)	4 (1)	0.0479
Any medical complication n (%)	200 (29)	108 (36)	0.0157

Table III. Treatment in diabetic and non‐diabetic patients with acute stroke

Treatment during hospitalization	Non‐diabetic patients, n = 696	Diabetic patients, n = 296	P value
Parenteral fluid n (%)	554 (80)	227 (77)	0.3057
Antibiotics n (%)	158 (23)	91 (31)	0.0075
Antipyretics n (%)	34 (5)	22 (7)	0.1116
Insulin n (%)	17 (2)	82 (28)	<0.0001
Antihypertensive therapy n (%)	285 (41)	148 (50)	0.0085
Heparin n (%)	446 (64)	200 (68)	0.2916
Parenteral nutrition n (%)	80 (11)	35 (12)	0.8818
Intensive care n (%)	76 (11)	22 (7)	0.0921
Thrombolysis n (%)	4 (1)	2 (1)	0.8511
Acetylsalicylic acid/antiplatelets n (%)	444 (64)	188 (64)	0.9332
Neurosurgery	3 (1)	0	0.2579
Treatment at discharge^a	n = 515	n = 227
Acetylsalicylic acid/antiplatelets n (%)	324 (63)	146 (64)	0.7144
Insulin/antidiabetics n (%)	4 (1)	127 (56)	<0.0001
Beta‐blockers n (%)	83 (16)	46 (20)	0.1695
ACE‐inhibitors n (%)	205 (40)	131 (58)	<0.0001
Diuretics n (%)	102 (20)	82 (36)	<0.0001
Ca‐antagonists n (%)	102 (20)	59 (26)	0.0596
Oral anticoagulation n (%)	72 (14)	20 (9)	0.0489

^a Only patients who were alive and not transferred to other departments were included.

Figure 1 Association of admission serum glucose levels with case fatality in diabetic and non‐diabetic patients.

Table IV. Prevalence of diabetes, co‐morbid conditions and case fatality in studies of acute stroke patients

Author/year	Patients (n)	Mean age (years)	Diabetes (%)	CAD^a (%)	AF^b (%)	Hyp^c (%)	ICH^d (%)	Case fatality diabetic/non‐diabetic patients (%)
(5) 1990	705	72	17	29	18	51	9	40/20
(6) 1988	428	72	18	26	21	54	10	28/15
(8) 1992	176	69	17	nr^e	nr^e	57	16	25/11
(9) 1992	327	68	22	nr^e	17	52	0	39/9
(10) 1994	1135	74	21	30	24	49	6	24/17
(12) 2003	4481	72	21	nr^e	18	49	11	20/22
present study	992	75	30	28	31	68	10	16/18

^a = Coronary artery disease, ^b = Atrial fibrillation, ^c = Arterial hypertension, ^d = Intracerebral hemorrhage, ^e = not reported