22. European Stroke Conference 539 Epidemiology of stroke How to detect previously undiagnosed diabetes in patients with acute stroke J. Tuomilehto1, K. Matz2, M. Brainin3 Center for Vascular Prevention, Danube University Krems, Krems, AUSTRIA1, Danube Uni-versity Krems, Krems, AUSTRIA2, Danube University Krems, Krems, AUSTRIA3 Background: Diabetes in acute stroke patients worsens the prognosis of the patients. A large propor-tion of patients with acute stroke have diabetes that was previously undiagnosed. It is unclear what the best method to diagnose diabetes may be: fasting plasma glucose (FPG) and/or 2-hour post-chal-lenge PG (2hPG) in an oral glucose tolerance test (OGTT) or HbA1c. Design: This study compares findings from an OGTT (FPG and 2hPG) and HbA1c as screening tools for undiagnosed diabetes in patients with acute stroke. Methods: Patients hospitalised for acute stroke had FPG, 2hPG and HbA1c 4 – 21 days after admis-sion as a screening process for an intervention study. Consecutively admitted acute stroke patients were screened for glucose tolerance according to the standardized World Health Organization OGTT protocol in the 1st and 2nd week after the stroke event. In addition, we measured HbA1c in these pa-tients. The prevalence of diabetes based on FPG and 2hPG and HbA1c values was compared. Results: Of the 238 patients, 20.2% had previously known diabetes. Of the patients without a pri-or diagnosis 20.3% were found to have diabetes on any one of the three criteria. According to the OGTT results 39.1% patients had a normal glucose tolerance, 45.9 % prediabetes and 15.0% diabe-tes. Of the 20 patients with diabetes according to the OGTT 12 were detected by high 2hPG alone, 3 by high FPG alone and 5 had both FPG and 2hPG high. Only 8 patients diagnosed with diabe-tes according to high HbA1c; one had T2D also according to FPG, 3 according to 2hPG and 4 by HbA1c alone. Thus, measuring HbA1c alone without proper glucose testing 70.4% of the cases of diabetes by either glucose or HbA1c criteria would have remained undetected. Conclusions: Diabetes is often unrecognised in patients with acute stroke. The sensitivity of HbA1c compared with an OGTT to detect undiagnosed diabetes is very low. An OGTT should be performed in all stroke patients without previous diagnosis of diabetes. 630 © 2013 S. Karger AG, Basel Scientific Programme 540 Epidemiology of stroke Prevalence and Characteristics of Internal Carotid Artery Stenosis in Extreme Old Age. B. Browne1, J.A. Harbison2, M.P. Colgan3, P. Madhavan4, S. O’Neill5, D. Moore6, Z. Martin7, K. Boyle8 Trinity College Dublin, Dublin, IRELAND1, Trinity College Dublin, Dublin, IRELAND2, St James’s Hospital, Dublin, IRELAND3, St James’s Hospital, Dublin, IRELAND4, St James’s Hospi-tal, Dublin, IRELAND5, St James’s Hospital, Dublin, IRELAND6, St James’s Hospital, Dublin, IRE-LAND7, Adenbrookes Hospital, Cambridge, UNITED KINGDOM8 Introduction: The prevalence of Carotid stenosis is thought to increase with age but no study to date has looked at the characteristics of Carotid disease in those in extreme old age (>90 years and older) as these patients are rarely considered for surgery or intervention and thus infrequently scanned. Methods: All subjects >89 years undergoing routine Carotid Ultrasound in an open access vascular imaging service over a 5 year period were identified and the more severe level of Internal Carotid artery Stenosis (NASCET Criteria) in either artery identified and recorded. Control populations of subjects who had not underhad undergone scans in their 60s, 70s and 80s were also identified. Results: 163 patients >89 years were scanned in the period, mean age 91.8 years. Some degree of carotid stenosis was found in 98.2% of this population. Prevalence of carotid stenosis of varying degrees in this group and younger control groups are outlined below. Compared to a population in their 80s, the oldest age group described to date, people in their 90s had a higher prevalence of mild carotid stenosis (maximal ICA stenosis 20-50%) (Chi Sq 14.55. p=0.0001) and a lower prevalence of moderate, severe or occlusive disease (maximal ICA stenosis >50%) (Chi sq 7.1 p=0.007). People in their 80s had a lower prevalence of severe or occlusive dis-ease than those in their 70s (Chi Sq 7.2. p=0.005). Conclusions: People of 90 years and older have a high prevalence of internal carotid stenosis but a comparatively low prevalence of more severe disease. Prevalence of severe stenosis peaks in the 8th Decade of life and of moderate stenosis in the 9th decade. This suggests an inverse relationship be-tween degree of carotid stenosis and life expectancy. Table.1 Maximum Degree of Internal Carotid Artery Stenosis Age n Minor (<20%) Mild (20-50%) Moderate (50- 70%) Severe (>70%) 90s 163 1.8% 68.1% 16.6% 13.5% 80s 213 8.0% 47.9% 26.3% 17.8% 70s 167 1.2% 45.5% 22.8% 30.5% 60s 258 10.0% 51.6% 15.9% 22.4%
Karger_ESC London_2013
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