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Using routine HbA1c measurements in stroke and the associations of dysglycaemia with stroke outcomes
Authors:Jeremy Lew  Vincent Thijs  Leonid Churilov  Geoffrey Donnan  Warwick Park  Raymond Robbins  Graeme K. Hart  Christopher Bladin  Kaylyn Khoo  Lik-Hui Lau  Alanna Tan  Que Lam  Douglas Johnson  Jeffrey D. Zajac  Elif I. Ekinci
Affiliation:1. Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia;2. Department of Medicine, Austin Health, The University of Melbourne, Australia;3. Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, Vic., Australia;4. Department of Neurology, Austin Health, Heidelberg, Vic., Australia;5. Department of Administrative Informatics, Austin Health, Heidelberg, Vic., Australia;6. Department of Intensive Care, Austin Health, Heidelberg, Vic., Australia;7. Health and Biomedical Informatics Centre, University of Melbourne, Australia;8. Department of Neurosciences, Eastern Health, Box Hill Hospital, Box Hill, Vic., Australia;9. Department of Pathology, Austin Health, Heidelberg, Vic., Australia;10. Department of General Medicine, Austin Health, Heidelberg, Vic., Australia
Abstract:

Aims

Diabetes is a major risk factor for stroke. We aimed to investigate the prevalence of diabetes and pre-diabetes within a stroke cohort and examine the association of glycaemia status with mortality and morbidity.

Methods

Inpatients aged ≥54 who presented with a diagnosis of stroke had a routine HbA1c measurement as part of the Austin Health Diabetes Discovery Initiative. Additional data were attained from hospital databases and Australian Stroke Clinical Registry. Outcomes included diabetes and pre-diabetes prevalence, length of stay, 6-month and in-hospital mortality, 28-day readmission rates, and 3-month modified Rankin scale score.

Results

Between July 2013 and December 2015, 610 patients were studied. Of these, 31% had diabetes while 40% had pre-diabetes. Using multivariable regression analyses, the presence of diabetes was associated with higher odds of 6-month mortality (OR?=?1.90, p?=?0.022) and higher expected length of stay (IRR?=?1.29, p?=?0.004). Similarly, a higher HbA1c was associated with higher odds of 6-month mortality (OR?=?1.27, p?=?0.005) and higher expected length of stay (IRR?=?1.08, p?=?0.010).

Conclusions

71% of this cohort had diabetes or pre-diabetes. Presence of diabetes and higher HbA1c were associated with higher 6-month mortality and length of stay. Further research is necessary to determine if improved glycaemic control may improve stroke outcomes.
Keywords:Hemoglobin A glycosylated  Diabetes mellitus  Stroke  Prevalence  Electronic Health Records
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