Newly-diagnosed Disturbed Glucose Metabolism after TIA or Stroke

Abstract

The prevalence of diabetes mellitus is increasing. Diabetes mellitus is an important risk factor for first stroke and stroke recurrence. Pre-diabetes is an intermediate metabolic state between normal glucose metabolism and diabetes mellitus and the prevalence of pre-diabetes is increasing as well. Pre-diabetes is a potential treatable risk factor, because it not only increases the risk of developing diabetes mellitus but also of cardiovascular diseases. With this thesis I have shown that more than 70% of the patients with a recent TIA or stroke without a history of diabetes had pre-diabetes or newly-diagnosed diabetes. Three tests are available to diagnose (pre-)diabetes: fasting plasma glucose, oral glucose tolerance test and glycosylated hemoglobin levels. Our study provides a rationale for the use of all three tests. Post-stroke hyperglycemia can be transient, reflecting an acute stress response, or persistent, representing undiagnosed disturbed glucose metabolism. It is important to differentiate between transient and persistent disturbed glucose metabolism and we developed a prediction model. Fasting plasma glucose, triglycerides and the use of cholesterol lowering drugs were the most important predictors. It remains unknown whether glucose-lowering drugs reduces the risk of recurrent stroke. In preparation of a phase III trial, we initiated a phase II trial (MAAS trial) to investigate the feasibility, safety and effects on glucose metabolism on glucose metabolism of glucose-lowering drugs. The results of this study are not known yet. Lastly we found an association between atherosclerosis and pre-diabetes and newly-diagnosed disturbed glucose metabolism after a TIA or ischemic stroke. This might be the underlying mechanism of the increased risk of recurrent stroke in these patients