Q J Med 2003; 96: 491-497
© 2003 Association of Physicians
Hyperglycaemia in patients with acute ischaemic stroke: how often do we screen for undiagnosed diabetes?
From the 1Clinical Epidemiology Research Center, 2Medical Service, and 3Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, and 4Department of Internal Medicine and 5Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
Received 1 November 2002 and in revised form 6 April 2003
Background: Hyperglycaemia is common among patients with acute ischaemic stroke, and may be due to the physiological stress of the acute stroke event or reflect underlying diabetes mellitus. The under-diagnosis of diabetes in the general population, combined with the association of diabetes and stroke, suggests a rationale for screening for diabetes among hyperglycaemic stroke patients.
Aim: To determine how often clinicians screen for diabetes among hyperglycaemic stroke patients without a prior diagnosis of diabetes.
Design: Retrospective medical record review.
Methods: We reviewed the records of acute ischaemic stroke patients admitted at any of ten Connecticut hospitals from May 1996 through December 1998.
Results: We identified 90 acute stroke patients with no prior history of diabetes. The prevalence of hyperglycaemia varied from 31% down to 6%, depending on the maximum glucose cut-off used to define hyperglycaemia: from 
140 mg/dl (7.8 mmol/l) to 200 mg/dl (11.1 mmol/l). Only one of the hyperglycaemic patients (1/90, 1%) had any evidence that a clinician screened or planned to screen for undiagnosed diabetes: one patient had a haemoglobin A1c measured during the hospitalization, none received oral glucose tolerance testing while hospitalized, and no discharge summary included a plan to screen for diabetes as an out-patient.
Discussion: Hyperglycaemic stroke patients without a previous diagnosis of diabetes are not routinely screened for diabetes. This situation represents an opportunity, currently unused, to identify an important and modifiable condition.
Address correspondence to Dr D.M. Bravata, Yale University School of Medicine, 333 Cedar Street, Room IE-61 SHM, PO Box 208025, New Haven, CT 06520-8025, USA. e-mail: Dawn.Bravata{at}yale.edu
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