HONOLULU—One in three survivors of acute ischemic stroke in the United States has undiagnosed prediabetes, according to results from a national survey presented at the 2013 International Stroke Conference. Black stroke survivors are more than twice as likely as whites to have undiagnosed prediabetes or diabetes mellitus, while Hispanics have an intermediate risk, reported Amytis Towfighi, MD.
Dr. Towfighi presented an analysis of 1,070 adult stroke survivors who were included in the National Health and Nutrition Examination Survey (NHNES), a CDC–sponsored cross-sectional survey weighted so as to be representative of the full US population. Thus, the findings from the NHANES stroke survivors can be extrapolated to the estimated 5.1 million adult stroke survivors nationwide.
The overall prevalence of prediabetes among stroke survivors, as defined by a hemoglobin A1C level of 5.7% to 6.4%, was 32.3%. The figure was 37.8% in blacks, 31.6% in Hispanics, and 26.3% in whites. Only 2.5% of stroke survivors had physician-diagnosed prediabetes, reported Dr. Towfighi, who is the Chair of the Neurology Department and Director of the Acute Neurology and Acute Stroke Unit at Rancho Los Amigos National Rehabilitation Center in Downey, California.
The prevalence of undiagnosed diabetes mellitus was 3.7% overall. In contrast, 26.9% of stroke survivors had diagnosed diabetes, with rates ranging from 42.7% in Hispanics to 35.7% in blacks and 24.4% in whites.
Black stroke survivors with undiagnosed prediabetes or diabetes were significantly younger: a mean age of 59, compared with 70 in whites and 67 in Hispanics. They were also significantly more likely to smoke and to be taking antihypertensive medications. Of black stroke survivors, 58% were women, compared with 42% of white stroke survivors.
Chronic hyperglycemia is a potent risk factor for vascular events. Thus, unrecognized prediabetes or diabetes may increase an individual's risk of recurrent stroke. Because prediabetes will progress to diabetes if it is left untreated, it makes sense to systematically screen patients for these metabolic abnormalities at the time of an index stroke as a means of improving clinical outcomes and reducing racial disparities, Dr. Towfighi said.
IMNG Medical News