Stress hyperglycemia may have higher risk of stroke recurrence than previously diagnosed diabetes mellitus
Yuzhou Guo, Guangyao Wang, Jing Jing, Anxin Wang, Xiaoli Zhang, Xia Meng, Xingquan Zhao, Liping Liu, Hao Li, David Wang, Yongjun Wang, Yilong Wang
Abstract
We aim to evaluate the risk of stroke recurrence among non-diabetes mellitus (non-DM), previously diagnosed diabetes mellitus (PDDM), newly diagnosed diabetes mellitus-related hyperglycemia (NDDM-RH) and stress hyperglycemia after minor stroke or TIA. Totally, 3026 patients with baseline fasting glucose and glycated albumin from the CHANCE trial (Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events) were included. Patients were classified as non-DM, PDDM, NDDM-RH and stress hyperglycemia according to the status of glucose metabolism. The primary outcome was stroke recurrence during 90-day follow up. Cox regression was performed to estimate the relationship between the status of glucose metabolism and risk of 90-day stroke recurrence. Compared with PDDM, NDDM-RH had a similar risk of 90-day stroke recurrence (hazard ratios [HR]1.39, 95% confidence intervals [CI] 0.94-2.04), while stress hyperglycemia had approximately a 5.3-fold increased risk of 90-day stroke recurrence after adjusted for confounding covariates (HR 5.32, 95% CI 3.43-8.26). Parallel results were found for 90-day recurrent ischemic stroke and composite events. Compared with PDDM in minor stroke or TIA, a parallel risk of 90-day stroke recurrence were observed for NDDM-RH, while stress hyperglycemia might relate to higher risk of 90-day stroke recurrence.