Abnormal glucose metabolism in non diabe
Q J Med 2010; 103:495–503
doi:10.1093/qjmed/hcq062 Advance Access Publication 28 April 2010
Abnormal glucose metabolism in non-diabetic patients
presenting with an acute stroke: prospective study and
systematic review
J.A. DAVE1, M.E. ENGEL2, R. FREERCKS1, J. PETER1, W. MAY1, M. BADRI2,
L. VAN NIEKERK1 and N.S. LEVITT1
Address correspondence to Dr J.A. Dave, Division of Diabetic Medicine and Endocrinology, Department of
Medicine, J-floor, Old Main Building, Groote Schuur Hospital, Anzio Road, Observatory, 7925, Cape Town,
South Africa. email: joel.dave@uct.ac.za
Received 21 August 2009 and in revised form 30 November 2009
Summary
Background: Non-diabetic patients presenting with
an acute stroke often have hyperglycaemia. In most
populations it is unknown whether the hyperglycaemia is transient and due to the acute stress
response or whether it represents undiagnosed
abnormal glucose metabolism.
Aim: To evaluate the prevalence and predictors of
persistent hyperglycaemia in non-diabetic patients
with an acute stroke.
Design: Prospective observational study.
Methods: Non-diabetic patients over 40 years old
with an acute stroke were enrolled over a 2-year
period. On admission patients were evaluated with
an HbA1c and a 75 g oral glucose tolerance test
(OGTT). The OGTT was repeated 3 months later.
A meta-analysis was performed to interpret our
results in the context of published data.
Results: One hundred and seven patients were analysed. On admission 26 (24%) patients had diabetes,
Introduction
There is a considerable global burden of diabetes. In
the year 2000, an estimated 171 million people
were affected by diabetes, whilst the excess global
39 (37%) had impaired glucose tolerance and
42 (39%) had normal glucose tolerance. Forty-four
(68%) patients with hyperglycaemia on admission
were re-investigated at least 3 months after
discharge. Of these, 6 (14%) had diabetes,
12 (27%) had impaired glucose tolerance and
26 (59%) had normal glucose tolerance. A 2-h
post-load glucose value 10 mmol/l predicted persistent hyperglycaemia with 72.2% sensitivity,
65.4% specificity and a positive predictive value
and negative predictive value of 59.1 and 77.3%,
respectively. A meta-analysis of prevalence data of
impaired glucose metabolism in non-diabetic individuals 3 months after having had an acute stroke
revealed a combined prevalence of 58% (95%
confidence interval 25.4–90.5%).
Conclusion: In this study hyperglycaemia in the
setting of an acute stroke was transient in the
majority of patients.
mortality attributable to diabetes was 2.9 million.
This accounted for 5.2% of all deaths.1 This excess
mortality was primarily due to cardiovascular disease (CVD), and is likely to rise as an estimated
! The Author 2010. Published by Oxford University Press on behalf of the Association of Physicians.
All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Downloaded from http://qjmed.oxfordjournals.org/ at National Guard Health Affairs (NGHA) on February 4, 2013
From the 1Division of Diabetic Medicine and Endocrinology and 2Department of Medicine, Groote
Schuur Hospital, 7925 Cape Town, South Africa
496
J.A. Dave et al.
Methods
Patients
Patients without known diabetes who were admitted
to two participating hospitals with a diagnosis of
acute stroke at specific times between July 2004
and 2006 were approached for participation in this
study. Exclusion criteria included: being
doi:10.1093/qjmed/hcq062 Advance Access Publication 28 April 2010
Abnormal glucose metabolism in non-diabetic patients
presenting with an acute stroke: prospective study and
systematic review
J.A. DAVE1, M.E. ENGEL2, R. FREERCKS1, J. PETER1, W. MAY1, M. BADRI2,
L. VAN NIEKERK1 and N.S. LEVITT1
Address correspondence to Dr J.A. Dave, Division of Diabetic Medicine and Endocrinology, Department of
Medicine, J-floor, Old Main Building, Groote Schuur Hospital, Anzio Road, Observatory, 7925, Cape Town,
South Africa. email: joel.dave@uct.ac.za
Received 21 August 2009 and in revised form 30 November 2009
Summary
Background: Non-diabetic patients presenting with
an acute stroke often have hyperglycaemia. In most
populations it is unknown whether the hyperglycaemia is transient and due to the acute stress
response or whether it represents undiagnosed
abnormal glucose metabolism.
Aim: To evaluate the prevalence and predictors of
persistent hyperglycaemia in non-diabetic patients
with an acute stroke.
Design: Prospective observational study.
Methods: Non-diabetic patients over 40 years old
with an acute stroke were enrolled over a 2-year
period. On admission patients were evaluated with
an HbA1c and a 75 g oral glucose tolerance test
(OGTT). The OGTT was repeated 3 months later.
A meta-analysis was performed to interpret our
results in the context of published data.
Results: One hundred and seven patients were analysed. On admission 26 (24%) patients had diabetes,
Introduction
There is a considerable global burden of diabetes. In
the year 2000, an estimated 171 million people
were affected by diabetes, whilst the excess global
39 (37%) had impaired glucose tolerance and
42 (39%) had normal glucose tolerance. Forty-four
(68%) patients with hyperglycaemia on admission
were re-investigated at least 3 months after
discharge. Of these, 6 (14%) had diabetes,
12 (27%) had impaired glucose tolerance and
26 (59%) had normal glucose tolerance. A 2-h
post-load glucose value 10 mmol/l predicted persistent hyperglycaemia with 72.2% sensitivity,
65.4% specificity and a positive predictive value
and negative predictive value of 59.1 and 77.3%,
respectively. A meta-analysis of prevalence data of
impaired glucose metabolism in non-diabetic individuals 3 months after having had an acute stroke
revealed a combined prevalence of 58% (95%
confidence interval 25.4–90.5%).
Conclusion: In this study hyperglycaemia in the
setting of an acute stroke was transient in the
majority of patients.
mortality attributable to diabetes was 2.9 million.
This accounted for 5.2% of all deaths.1 This excess
mortality was primarily due to cardiovascular disease (CVD), and is likely to rise as an estimated
! The Author 2010. Published by Oxford University Press on behalf of the Association of Physicians.
All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Downloaded from http://qjmed.oxfordjournals.org/ at National Guard Health Affairs (NGHA) on February 4, 2013
From the 1Division of Diabetic Medicine and Endocrinology and 2Department of Medicine, Groote
Schuur Hospital, 7925 Cape Town, South Africa
496
J.A. Dave et al.
Methods
Patients
Patients without known diabetes who were admitted
to two participating hospitals with a diagnosis of
acute stroke at specific times between July 2004
and 2006 were approached for participation in this
study. Exclusion criteria included: being