Abstract 4147634: Important Role of Prediabetes in Stroke Patients including ESUS

Stroke including ESUS is one of the common causes of disability and death worldwide. Furthermore, diabetes mellitus and prediabetes are among the main risk factors for cerebrovascular events. If the criteria for apparent diabetes mellitus is not met, a glucose metabolism disorder may still exist. Prediabetes can be present as impaired fasting glucose (IFG), impaired glucose tolerance or an increased, but not yet diabetic, HbA1c. To determine the frequency of diabetes mellitus (DM) and prediabetes mellitus (PDM) in patients with cardiovascular events, we analyzed the aspects of prediabetes in a stroke population of one of the largest stroke centers in Germany and collected the data in a prospective manner over 6 months. Among 714 included patients, 163 (30.8%) suffered a cryptogenic Stroke, including 98 (19%) ESUS. 185 (26%) TIA, 209 (39%) cardioembolic, 110 (21%) atherosclerotic, 40 (8%) lacunar and 7 (1%) other specific strokes were registered. >50% had a diabetic or prediabetic metabolic state, among which, the highest proportion was seen in lacunar strokes, followed by atherosclerotic infarctions. >80% of lacunar, >70% of atherosclerotic infarctions, 60% of ESUS, 50% of cardioembolic infarctions indicate DM or PDM. Both PDM and DM show a positive correlation with age. PDM is most common in 75-84y old patients. In the male population, PDM is most prevalent in the oldest patients (<85y) at >50%, and least prevalent in the youngest patients (<65y) at 15%. In this age group, women show a significantly higher frequency of DM and PDM. The highest number of female patients with glucose metabolism disorders is seen in the age group of 66-74y at >40%. In the oldest patient group, relatively speaking, more than twice as many men are affected by glucose metabolism disorders as women (52% vs. 24%). In summary the largest relative proportion of prediabetics and diabetics is seen at 80% among the lacunar infarction group and the second largest proportion at 70% among those with atherosclerotic infarctions. Among ESUS and cryptogenic stroke patients show a proportion of over 60% with impaired glucose tolerance. PD presents a positive correlation with increasing age, just like other risk factors. 40% of the 75-84-year-olds have DM or PDM. Therefore, diabetogenic micro- and macroangiopathies could be a major contributing factor to the causes of stroke.