The prevalence of Diabetes and its effects on Stroke Outcomes; a meta-analysis and literature review.

Abstract

Diabetes Mellitus is an established risk factor for stroke and maybe associated with poorer outcomes following stroke. The aims of this literature review were to determine (i) the prevalence of diabetes in acute stroke patients through a meta-analysis, (ii) the association between diabetes and outcomes after ischemic and hemorrhagic stroke and (iii) to review the value of HbA1c and admission glucose based tests in predicting stroke outcomes. Ovid MEDLINE and EMBASE searches were conducted to find studies relating diabetes and inpatient stroke populations published between January 2004 and April 2017. A meta-analysis of the prevalence of diabetes from included studies was conducted. A narrative review on the associations of diabetes and different diagnostic methods on stroke outcomes was performed. Sixty-six eligible articles met inclusion criteria. A meta-analysis of 39 studies (n=359,783) estimated the prevalence of diabetes to be 28% (95%CI [26, 31]). The rate was higher in ischemic (33%, 95%CI [28, 38]) compared to hemorrhagic stroke (26%, 95%CI [19, 33]) inpatients. Most, but not all studies found that acute hyperglycemia and diabetes were associated with poorer outcomes after ischemic or hemorrhagic strokes: including higher mortality, poorer neurological and functional outcomes, longer hospital stay, higher readmission rates and stroke recurrence. Diagnostic methods for establishing diagnosis were heterogeneous between the reviewed studies. Approximately one-third of all stroke patients have diabetes. Uniform methods to screen for diabetes after stroke are required to identify individuals with diabetes to design interventions aimed at reducing poor outcomes in this high risk population. This article is protected by copyright. All rights reserved.