Canadian Diabetes Association Clinical Practice Guidelines

Management of Stroke in Diabetes

Chapter 27

Michael Sharma, Gord Gubitz

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association

SCREEN for diabetes in all patients admitted with ischemic stroke or Transient Ischemic Attack (TIA)

MANAGE in-hospital glycemia as one would for any other reason for admission

TREAT the ischemic stroke or TIA in a patient with diabetes the same as a patient without diabetes, using Canadian Stroke Strategy Best Practices Recommendation

http://www.strokebestpractices.ca

2013Stroke in Diabetes Checklist

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association

Patients with DM are 2-3X More Likely to Have a Stroke

Public Health Agency of Canada (August 2011); using 2008/09 data from the Canadian Chronic Disease Surveillance System (Public Health Agency of Canada).

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association

Idris I, et al. Int J Clin Pract 2006;60:48-56.

People with Diabetes and Stroke Have Worse Outcomes

• Increased hospital and long-term mortality

• More residual neurologic disability

• More residual functional disability

• Longer hospital stays

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association

Bellolio MF, et al. Cochrane Database of Systematic Reviews 2011 Sep 7;(9):CD005346.doi:10.1002/13651858.CD005346.pub3.

Treat Glycemia the Same as in Other Conditions

• Usually premeal BG 5-8 mmol/L, random <10 mmol/L

• Cochrane Systematic Review of 7 randomized

controlled trials of intensive insulin therapy (target BG

4-7.5 mmol/L) versus usual care in acute ischemic

stroke showed no benefit in the outcomes of death,

disability or dependence, and there was an increase

in hypoglycemia

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association

1. Patients with ischemic stroke or transient ischemic

attack should be screened for diabetes with a

fasting plasma glucose, A1C, or 75-g OGTT soon

after admission to hospital [Grade D, Consensus]

2. All patients with diabetes and ischemic stroke or

transient ischemic attack (TIA) should receive the

same treatments that are recommended for

patients with ischemic stroke or TIA without diabetes

since they benefit equally [Grade D, Consensus]

2013Recommendations 1 and 2

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association

CDA Clinical Practice Guidelines

http://guidelines.diabetes.ca – for professionals

1-800-BANTING (226-8464)

http://diabetes.ca – for patients