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Meta-Analysis
. 2013 Jul;44(7):1915-23.
doi: 10.1161/STROKEAHA.111.000813. Epub 2013 May 23.

Diabetes mellitus, admission glucose, and outcomes after stroke thrombolysis: a registry and systematic review

Jean-Philippe Desilles  1 , Elena Meseguer, Julien Labreuche, Bertrand Lapergue, Gaia Sirimarco, Jaime Gonzalez-Valcarcel, Philippa Lavallée, Lucie Cabrejo, Celine Guidoux, Isabelle Klein, Pierre Amarenco, Mikael Mazighi
Affiliations
Meta-Analysis

Diabetes mellitus, admission glucose, and outcomes after stroke thrombolysis: a registry and systematic review

Jean-Philippe Desilles et al. Stroke. 2013 Jul.

Abstract

Background and purpose: The potential detrimental effect of diabetes mellitus and admission glucose level (AGL) on outcomes after stroke thrombolysis is unclear. We evaluated outcomes of patients treated by intravenous and/or intra-arterial therapy, according to diabetes mellitus and AGL.

Methods: We analyzed data from a patient registry (n=704) and conducted a systematic review of previous observational studies. The primary study outcome was the percentage of patients who achieved a favorable outcome (modified Rankin score ≤2 at 3 months).

Results: We identified 54 previous reports that evaluated the effect of diabetes mellitus or AGL on outcomes after thrombolysis. In an unadjusted meta-analysis that included our registry data and previous available observational data, diabetes mellitus was associated with less favorable outcome (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.73-0.79) and more symptomatic intracranial hemorrhage (OR, 1.38; 95% CI, 1.21-1.56). However, in multivariable analysis, diabetes mellitus remained associated with less favorable outcome (OR, 0.77; 95% CI, 0.69-0.87) but not with symptomatic intracranial hemorrhage (OR, 1.11; 95% CI, 0.83-1.48). In unadjusted and in adjusted meta-analysis, higher AGL was associated with less favorable outcome and more symptomatic intracranial hemorrhage; the adjusted OR (95% CI) per 1 mmol/L increase in AGL was 0.92 (0.90-0.94) for favorable outcome, and 1.09 (1.04-1.14) for symptomatic intracranial hemorrhage.

Conclusions: These results confirm that AGL and history of diabetes mellitus are associated with poor clinical outcome after thrombolysis. AGL may be a surrogate marker of brain infarction severity rather than a causal factor. However, randomized controlled evidences are needed to address the significance of a tight glucose control during thrombolysis on clinical outcome.

Keywords: acute stroke syndromes; diabetes mellitus; glucose; thrombolysis.

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