FREQUENCY OF UNDIAGNOSED DIABETES MELLITUS IN PATIENTS WITH ISCHEMIC STROKE
Main Article Content
Keywords
undiagnosed diabetes mellitus, ischemic stroke, frequency, HbA1c, fasting plasma glucose, cardiovascular risk factors
Abstract
Introduction: Diabetes mellitus is a significant risk factor for ischemic stroke, but many patients have an unrecognized diabetes prior to stroke.
Objective: To determine the frequency of undiagnosed diabetes mellitus in patients with ischemic stroke.
Methods: This descriptive cross-sectional study was done in the Hameed Latif Hospital Lahore from March, 2025 to August, 2025. Patients aged 18 years and older who had been diagnosed with ischemic stroke (IS) by computed tomography (CT) or magnetic resonance image (MRI) were recruited by non-probability consecutive sampling, for a total of 150 patients. Those with known diabetes were not included. Fasting plasma glucose and glycated hemoglobin (HbA1c) were measured and diabetes was defined as FPG ≥ 126 mg/dL or HbA1c ≥ 6.5%. Descriptive statistics were used.
Results: The mean age was 59.4 ± 11.8 years, and 91 patients (60.7%) were male. Undiagnosed diabetes was identified in 31 patients (20.7%; 95% CI 15.0 to 27.8). It was more frequent in patients aged 60 years or above (64.5% vs 51.3%) and often coexisted with hypertension (74.2%), dyslipidemia (54.8%), smoking (38.7%), and obesity (32.3%). The mean fasting glucose and HbA1c in this group were 148.6 ± 24.8 mg/dL and 7.1 ± 0.6%, respectively.
Conclusions: About 20% of ischemic stroke patients did not have a previous diagnosis of diabetes. It is recommended to do routine glucose and HbA1c testing at admission to allow early treatment and secondary prevention.
References
2.Liu J, Li X, Qu J. Risk factors for acute ischemic stroke in patients with type 2 diabetes mellitus. Medicine. 2023 Nov 24;102(47):e36114.
3.Maida CD, Daidone M, Pacinella G, Norrito RL, Pinto A, Tuttolomondo A. Diabetes and ischemic stroke: an old and new relationship an overview of the close interaction between these diseases. International Journal of Molecular Sciences. 2022 Feb 21;23(4):2397.
4.Maida CD, Daidone M, Pacinella G, Norrito RL, Pinto A, Tuttolomondo A. Diabetes and ischemic stroke: an old and new relationship an overview of the close interaction between these diseases. International Journal of Molecular Sciences. 2022 Feb 21;23(4):2397.
5.Chang KC, Lin CH, Huang JA. Use of Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Is Associated With a Reduced Risk of Poststroke Epilepsy in Patients With Ischemic Stroke. Journal of the American Heart Association. 2024 Sep 3;13(17):e035438.
6.Xu C, Cai L, Yi T, Yi X, Hu Y. Neutrophil‐to‐lymphocyte ratio is associated with stroke progression and functional outcome in patients with ischemic stroke. Brain and Behavior. 2023 Nov;13(11):e3261.
7.Kristiansen MH, Kjær L, Skov V, Larsen MK, Ellervik C, Hasselbalch HC, Wienecke T. JAK2V617F mutation is highly prevalent in patients with ischemic stroke: a case-control study. Blood advances. 2023 Oct 10;7(19):5825-34.
8.Teppo K, Airaksinen KJ, Jaakkola J, Halminen O, Salmela B, Kouki E, Haukka J, Putaala J, Linna M, Aro AL, Mustonen P. Ischaemic stroke in women with atrial fibrillation: temporal trends and clinical implications. European heart journal. 2024 May 21;45(20):1819-27.
9.Jeong SM, Yoo JE, Park J, Jung W, Lee KN, Han K, Lee CM, Nam KW, Lee SP, Shin DW. Smoking behavior change and risk of cardiovascular disease incidence and mortality in patients with type 2 diabetes mellitus. Cardiovascular Diabetology. 2023 Jul 29;22(1):193.
10.Ha J, Choi DW, Kim KJ, Kim KY, Nam CM, Kim E. Pioglitazone use and reduced risk of dementia in patients with diabetes mellitus with a history of ischemic stroke. Neurology. 2023 Apr 25;100(17):e1799-811.
11.Buckley BJ, Harrison SL, Hill A, Underhill P, Lane DA, Lip GY. Stroke-heart syndrome: incidence and clinical outcomes of cardiac complications following stroke.
12.Yoshida Y, Chen Z, Fonseca VA, Mauvais-Jarvis F. Sex differences in cardiovascular risk associated with prediabetes and undiagnosed diabetes. American journal of preventive medicine. 2023 Nov 1;65(5):854-62.
13.Kamtchum-Tatuene J, Farrell J, Nolan J, Lessels S, Whiteley WN, Li L, CVD-COVID-UK/COVID-IMPACT Consortium. Time trends in stroke incidence and modifiable risk factor prevalence in England (2018–2024): A record linkage population-based study. PLoS medicine. 2026 Aug 7;23(8):e1004999.
14.Noubiap JJ, Tang JJ, Teraoka JT, Dewland TA, Marcus GM. Minimum national prevalence of diagnosed atrial fibrillation inferred from California acute care facilities. Journal of the American College of Cardiology. 2024 Oct 15;84(16):1501-8.
15.Huang Z, Ding X, Yue Q, Wang X, Chen Z, Cai Z, Li W, Cai Z, Chen G, Lan Y, Wu W. Triglyceride-glucose index trajectory and stroke incidence in patients with hypertension: a prospective cohort study. Cardiovascular diabetology. 2022 Jul 27;21(1):141.
16.Ohya Y, Matsuo R, Sato N, Irie F, Nakamura K, Wakisaka Y, Ago T, Kamouchi M, Kitazono T, Investigators for Fukuoka Stroke Registry. Causes of ischemic stroke in young adults versus non-young adults: a multicenter hospital-based observational study. PLoS One. 2022 Jul 13;17(7):e0268481.
17.Golubnitschaja O, Potuznik P, Polivka Jr J, Pesta M, Kaverina O, Pieper CC, Kropp M, Thumann G, Erb C, Karabatsiakis A, Stetkarova I. Ischemic stroke of unclear aetiology: a case-by-case analysis and call for a multi-professional predictive, preventive and personalised approach. EPMA Journal. 2022 Dec;13(4):535-45.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Namra Zulfiqar, Medical Officer, Department of Medical ICU, Hameed Latif Hospital, Lahore, Pakistan
