Comparison of oral glucose tolerance test and HbA1c in detection of disorders of glucose metabolism in patients with acute stroke

Karl Matz, Jaakko Tuomilehto, Yvonne Teuschl, Alexandra Dachenhausen, Michael Brainin, Karl Matz, Jaakko Tuomilehto, Yvonne Teuschl, Alexandra Dachenhausen, Michael Brainin

Abstract

Background: Diabetes is an increasingly important risk factor for ischemic stroke and worsens stroke prognosis. Yet a large proportion of stroke patients who are eventually diabetic are undiagnosed. Therefore, it is important to have sensitive assessment of unrecognized hyperglycaemia in stroke patients.

Design: Secondary outcome analysis of a randomized controlled trial focussing on parameters of glucose metabolism and detection of diabetes and prediabetes in patients with acute ischemic stroke (AIS).

Methods: A total of 130 consecutively admitted patients with AIS without previously known type 2 diabetes mellitus (T2DM) were screened for diabetes or prediabetes as part of secondary outcome analysis of a randomized controlled trial that tested lifestyle intervention to prevent post-stroke cognitive decline. Patients had the oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) measurements in the second week after stroke onset and after 1 year. The detection rates of diabetes and prediabetes based on the OGTT or HbA1c values were compared.

Results: By any of the applied tests at the second week after stroke onset 62 of 130 patients (48%) had prediabetes or T2DM. Seventy-five patients had results from both tests available, the OGTT and HbA1c; according to the OGTT 40 (53.3%) patients had normal glucose metabolism, 33 (44%) had prediabetes, two (2.7%) T2DM. In 50 (66.7%) patients the HbA1c results were normal, 24 (32%) in the prediabetic and one (1.3%) in the diabetic range. The detection rate for disorders of glucose metabolism was 10% higher (absolute difference; relative difference 29%) with the OGTT compared with HbA1c. After 1 year the detection rate for prediabetes or T2DM was 7% higher with the OGTT (26% relative difference). The study intervention led to a more favourable evolution of glycemic status after 1 year.

Conclusion: The OGTT is a more sensitive screening tool than HbA1c for the detection of previously unrecognized glycemic disorders in patients with acute stroke with an at least a 25% relative difference in detection rate. Therefore, an OGTT should be performed in all patients with stroke with no history of diabetes. Trial registration https://ichgcp.net/clinical-trials-registry/NCT01109836" title="See in ClinicalTrials.gov">NCT01109836.

Keywords: Acute stroke; Fasting glucose; Glucose abnormalities; HbA1c; Oral glucose tolerance test; Risk assessment; Type 2 diabetes.

Conflict of interest statement

The authors declare to have no competing interest with the topic of this publication.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram of classification for disorders of glucose metabolism during the ASPIS randomized controlled trial
Fig. 2
Fig. 2
Percentage of progressive diabetic metabolic disorder (DMD), stable or improved glucose metabolism (GM) between baseline and 1 year follow up in the multifactorial intervention group of the ASPIS trial and in controls. Both, OGTT and HbA1c were used for diagnosis, patients were classified to PD or T2DM if either the OGTT or HbA1c criteria were fulfilled. Progressive DMD was defined as progression from normal GM to PD or T2DM or from PD to T2DM, improved GM as change of GM in the opposite direction

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Source: PubMed

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