Management of Hyperglycaemia after Stroke

AbstractBackground: UK national stroke guidelines recommend screening patients for undiagnosed diabetes mellitus within one week of stroke onset, and intervening to moderate hyperglycaemia. We sought to examine the management of hyperglycaemia in an NHS Trust in Northern Ireland.Methods: In a multicentre retrospective cohort study we reviewed the case notes of patients admitted with acute stroke to the three hospitals in the Trust from January 1, 2008 until April 15, 2008. We compared management with national guideline recommendations.Results: 112 patients with stroke were identified; 94 patients with no prior history of diabetes mellitus, 16 patients with type 2 diabetes mellitus and 2 patients with type 1 diabetes mellitus. The prevalence of hyperglycaemia above 7.8 mmol per litre in the first 5 days of admission ranged from 24% to 34%. Hyperglycaemia was under-monitored and undertreated. Of the 94 patients with no prior history of diabetes mellitus, there was evidence that 70% had fasting glucose tested, 5% had haemoglobin A1C tested, and none had an oral glucose tolerance test.Conclusion: Hyperglycaemia in hospitalized stroke patients is under-monitored and undertreated. Although glycaemic control in acute stroke may not conclusively alter short term outcome, better identification of undiagnosed diabetes mellitus and subsequent management represents an important opportunity for vascular protection.