Jennifer Dearborn, MD

Jia Q, Liu G, Zheng H, Zhao X, Wang C, Wang Y, et al. Impaired Glucose Regulation Predicted 1-Year Mortality of Chinese Patients With Ischemic Stroke: Data From Abnormal Glucose Regulationin Patients With Acute Stroke Across China. Stroke. 2014

Impaired glucose tolerance is a spectrum, and often clinical outcomes in stroke are addressed with consideration only to diabetic patients. This study sought to characterize impaired glucose tolerance and prediabetes in outcomes after stroke in a Chinese population. The ACROSS-China study enrolled 2,639 patients with ischemic stroke and measured glucose tolerance using the WHO criteria of impaired fasting glucose and/or impaired 2-hour glucose tolerance test. The outcome of the study was stroke mortality. The HR of death at one year was 3.2 (95% CI 1.6, 6.6) after adjustments. The majority of the stroke deaths at one year were categorized as secondary to the stroke itself. 12% of participants died at one year, and the median NIHSS on admission was 4 in both groups, so severity of presenting stroke seemed not to account for the difference in mortality. There was no difference on dependency or stroke recurrence between groups at one year. 

This large, well-orchestrated prospective study shows convincing evidence that stroke mortality is increased by glucose intolerance. Several questions, however, remain after consideration of these results. The first is, what were some details about the deaths in study, and how could these characteristics account for the comorbidity of glucose intolerance? For example, were the majority of deaths within the first 30-days, because thereafter, the death was likely not secondary to the stroke itself, but more likely complications of infection, VTE, MI, or other post-stroke complications. Lastly, is it important to consider the difference between diabetics and pre-diabetics in terms of mortality, as this was not delineated. This is important evidence that measuring the impact of glucose intolerance after stroke is critical to improve post-stroke care.