One in three stroke survivors in the United States has undiagnosed prediabetes, a national survey has shown.
Black stroke survivors are more than twice as likely as whites to have undiagnosed prediabetes or diabetes mellitus, while Hispanics have an intermediate risk, Dr. Amytis Towfighi said at the International Stroke Conference sponsored by the American Heart Association.
Amytis Towfighi
She presented an analysis of 1,070 adult stroke survivors included in the National Health and Nutrition Examination Survey, a Centers for Disease Control and Prevention–sponsored cross-sectional survey weighted so as to be representative of the full U.S. population. Thus, the findings in the NHANES stroke survivors can be extrapolated to the estimated 5.1 million adult stroke survivors nationwide.
The overall prevalence of prediabetes among stroke survivors as defined by a hemoglobin A1c level of 5.7%-6.4% was 32.3%. The figure was 37.8% in blacks, 31.6% in Hispanics, and 26.3% in whites. Only 2.5% of stroke survivors had physician-diagnosed prediabetes, reported Dr. Towfighi, who is chair of the neurology department and director of the acute neurology and acute stroke unit at Rancho Los Amigos National Rehabilitation Center, Downey, Calif.
The prevalence of undiagnosed diabetes mellitus was 3.7% overall. In contrast, 26.9% of stroke survivors had diagnosed diabetes, with rates ranging from 42.7% in Hispanics to 35.7% in blacks and 24.4% in whites.
Black stroke survivors with undiagnosed prediabetes or diabetes were significantly younger: a mean of 59 years old compared with 70 years in whites and 67 years in Hispanics. They were also significantly more likely to smoke and to be on antihypertensive medications. Of black stroke survivors, 58% were women compared with 42% of white stroke survivors.
Chronic hyperglycemia is a potent risk factor for vascular events. Thus, unrecognized prediabetes or diabetes may amplify an individual’s risk of recurrent stroke. Given that if left untreated, prediabetes will progress to diabetes, it makes sense to systematically screen patients for these metabolic abnormalities at the time of an index stroke as a means of improving clinical outcomes and reducing racial disparities, Dr. Towfighi said.
She reported having no relevant financial conflicts.