Introduction and objectives:
Diabetes is an increasing burden worldwide and is a major risk factor for stroke. We aimed (i) to investigate the prevalence of diabetes and pre-diabetes within the stroke cohort within a large tertiary hospital and (ii) examine the association of glycaemia status with patient mortality and morbidity.
Patients aged 54 or over who presented with a diagnosis of stroke had an HbA1c measurement as part of the Austin Health Diabetes Discovery Initiative. Risk factors and outcomes were attained from the hospital stroke database, clinical informatics department and the Australian stroke clinical registry. Outcomes included the prevalence of known and previously unrecognised diabetes and pre-diabetes, length of stay (LOS), 6-month and in-hospital mortality, 28-day readmission rates, and 3-month modified Rankin scale score (mRS).
Between July 2013 until December 2015, 612 patients aged 54 or over were admitted to Austin Health with the primary diagnosis of haemorrhagic or ischaemic stroke. Of these, 27% had diabetes while 40% had pre-diabetes (HbA1c 5.7%-6.4%). Of the 612 patients, 450 had complete data on age, Charlson co-morbidity index excluding diabetes, atrial fibrillation status and ambulation status, with 360 having data on 6-month mortality. Using logistics regression and analysing HbA1c as a continuous variable adjusting for the listed variables, higher HbA1c was associated with greater risk of death at 6 months (OR=1.346, p=0.018). The presence of diabetes, pre-diabetes or higher HbA1c were not associated with increased LOS, 28-day readmission rate, in-hospital mortality and 3-month mRS.
In this study, a combined 67% of stroke inpatients aged 54 or over had either diabetes or pre-diabetes. Presence of a higher HbA1c was associated with greater risk of 6 month mortality. Further interventional studies following stroke in patients with diabetes may be necessary to improve mortality outcomes in this cohort of patients.