Gray Christopher S, Scott Jon F, French Joyce M, Alberti K G M M, O'Connell Janice E
Newcastle University Department of Medicine for the Elderly, F Floor, Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK.
Age Ageing. 2004 Jan;33(1):71-7. doi: 10.1093/ageing/afh026.
diabetes mellitus not only increases the risk of ischaemic stroke two- to four-fold but also adversely inXuences prognosis. The prevalence of recognised diabetes mellitus in acute stroke patients is between 8 and 20%, but between 6 and 42% of patients may have undiagnosed diabetes mellitus before presentation. Post-stroke hyperglycaemia is frequent and of limited diagnostic value and the oral glucose tolerance test assumes that the patient is clinically stable and eating normally. There is a need for a simple and reliable method to predict new diabetes mellitus in acute stroke patients.
to determine the prevalence of unrecognised diabetes mellitus and impaired glucose tolerance on hospital admission and 12 weeks later in acute stroke patients with post-stroke hyperglycaemia > or = 6.1 mmol/l. To measure the accuracy of hyperglycaemia and elevated glycosylated haemoglobin concentration in predicting the presence of unrecognised diabetes mellitus at 12 weeks.
acute (<24 hours) stroke patients (cerebral infarction and primary intracerebral haemorrhage) with admission hyperglycaemia between 6.0 and 17 mmol/l and without a previous history of insulin-treated diabetes mellitus who were randomised into the Glucose Insulin in Stroke Trial between October 1997 and May 1999 were studied. The Glucose Insulin in Stroke Trial is a randomised controlled trial investigating the benefits of maintaining euglycaemia in acute stroke patients with mild to moderate hyperglycaemia. At 12 weeks, survivors underwent a 75 g oral glucose tolerance test. The positive predictive value and negative predictive value of admission plasma glucose > or = 6.1 mmol/l and elevated glycosylated haemoglobin concentration in predicting the presence of diabetes mellitus were used to estimate the prevalence of unrecognised diabetes mellitus in a consecutive series of 582 acute stroke admissions.
582 consecutive acute stroke patients were assessed for eligibility for the Glucose Insulin Stroke Trial, of whom 83 (14%) had recognised diabetes mellitus. One hundred and forty-two patients were randomised and 62 underwent a 3-month oral glucose tolerance test, of whom 26 (42%) had normal glucose tolerance, 23 (37%) had impaired glucose tolerance and 13 (21%) had diabetes mellitus. Admission plasma glucose > or = 6.1 mmol/l and glycosylated haemoglobin > or = 6.2% predicted the presence of previously unrecognised diabetes mellitus at 12 weeks with a positive predictive value of 80% and negative predictive value of 96%. The estimated prevalence of unrecognised diabetes mellitus in the total series of acute stroke admissions was 16-24%.
one-third of all acute stroke patients may have diabetes mellitus. For patients presenting with post-stroke hyperglycaemia, impaired glucose tolerance or diabetes mellitus is present in two-thirds of survivors at 12 weeks. Admission plasma glucose > or = 6.1 mmol/l combined with glycosylated haemoglobin > or = 6.2% are good predictors of the presence of diabetes mellitus following stroke.
糖尿病不仅使缺血性中风的风险增加两至四倍，还会对预后产生不利影响。急性中风患者中已确诊糖尿病的患病率在8%至20%之间，但6%至42%的患者在发病前可能患有未确诊的糖尿病。中风后高血糖很常见，且诊断价值有限，口服葡萄糖耐量试验假定患者临床稳定且饮食正常。需要一种简单可靠的方法来预测急性中风患者新发糖尿病。
确定急性中风后高血糖≥6.1 mmol/l的患者入院时及12周后未确诊糖尿病和糖耐量受损的患病率。测量高血糖和糖化血红蛋白浓度升高在预测12周时未确诊糖尿病存在方面的准确性。
对1997年10月至1999年5月期间随机纳入中风葡萄糖胰岛素试验的急性（<24小时）中风患者（脑梗死和原发性脑出血）进行研究，这些患者入院时血糖在6.0至17 mmol/l之间，且既往无胰岛素治疗糖尿病史。中风葡萄糖胰岛素试验是一项随机对照试验，研究在轻度至中度高血糖的急性中风患者中维持血糖正常的益处。12周时，幸存者接受75克口服葡萄糖耐量试验。入院时血浆葡萄糖≥6.1 mmol/l和糖化血红蛋白浓度升高在预测糖尿病存在方面的阳性预测值和阴性预测值，用于估计连续582例急性中风入院患者中未确诊糖尿病的患病率。
对582例连续急性中风患者评估是否符合中风葡萄糖胰岛素试验的入选标准，其中83例（14%）患有已确诊糖尿病。142例患者被随机分组，62例接受了3个月的口服葡萄糖耐量试验，其中26例（42%）糖耐量正常，23例（37%）糖耐量受损，13例（21%）患有糖尿病。入院时血浆葡萄糖≥6.1 mmol/l和糖化血红蛋白≥6.2%预测12周时存在先前未确诊糖尿病的阳性预测值为80%，阴性预测值为96%。在所有急性中风入院患者系列中，未确诊糖尿病的估计患病率为16% - 24%。
所有急性中风患者中有三分之一可能患有糖尿病。对于中风后出现高血糖的患者，三分之二的幸存者在12周时存在糖耐量受损或糖尿病。入院时血浆葡萄糖≥6.1 mmol/l并结合糖化血红蛋白≥6.2%是中风后糖尿病存在的良好预测指标。
