HbA1c measurement and relationship to incident stroke

NMUH Staff Publications

33

<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;">AIMS:</h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;">To determine the proportion of people with diabetes who have <span class="highlight">HbA1c</span> measured, what proportion achieve an <span class="highlight">HbA1c</span> level of < 58 mmol/mol (7.5%), the frequency of testing and if there was any change in <span class="highlight">HbA1c</span> level in the year before and the year after an incident stroke.</p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;">METHODS:</h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;">This study used the Secure Anonymised Information Linkage (SAIL) databank, which stores hospital data for the whole of Wales and ~ 65% of Welsh general practice records, to identify cases of stroke in patients with diabetes between 2000 and 2010. These were matched against patients with diabetes but without stroke disease. We assessed the frequency of <span class="highlight">HbA1c</span> testing and change in <span class="highlight">HbA1c</span> in the first year after stroke. Estimation was made of the proportion of patients achieving an <span class="highlight">HbA1c</span> measurement ≤ 58 mmol/mol (7.5%).</p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;">RESULTS:</h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;">There were 1741 patients with diabetes and stroke. Of these, 1173 (67.4%) had their <span class="highlight">HbA1c</span> checked before their stroke and 1137 (65.3%) after their stroke. In the control group of 16 838 patients with diabetes but no stroke, 8413 (49.9%) and 9288 (55.1%) had their <span class="highlight">HbA1c</span> checked before and after the case-matched stroke date, respectively. In patients with diabetes and stroke,<span class="highlight">HbA1c</span> fell from 61-56 mmol/mol (7.7-7.3%) after their stroke (P < 0.001). Before the study, 55.0% of patients with stroke had an<span class="highlight">HbA1c</span> ≥ 58 mmol/mol compared with 65.2% of control patients, these figures were 62.5% and 65.3% after the stroke.</p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;">CONCLUSIONS:</h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;">The frequency of diabetes testing was higher in patients who had experienced a stroke before and after their incident stroke compared with control patients but did not increase after their stroke. Glucose control improved significantly in the year after a stroke.</p>