Hyvärinen M et al. (2008) Hyperglycemia and stroke mortality—comparison between fasting and 2-hour glucose criteria. Diabetes Care [doi:10.2337/dc08-1411]

Nondiabetic individuals with elevated blood-glucose levels could be at increased risk of stroke. The Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) study group has, therefore, assessed the potential relationship between hyperglycemia and stroke mortality, and compared two diagnostic criteria for stroke-risk prediction.

Hyvärinen and colleagues enrolled 21,706 individuals (55% of whom were men) from 13 European cohorts, in which the mean age ranged from 45 to 76 years. Median duration of follow-up was 10.5 years. Diabetes mellitus had previously been diagnosed in 5.5% of the study population. Hyperglycemia was defined by the fasting plasma-glucose (PG) level or the 2 h post-challenge PG level in participants without previously diagnosed diabetes mellitus.

The risk of stroke mortality was increased in participants with known diabetes mellitus. The risk was also increased for individuals with hyperglycemia, regardless of the diagnostic criteria used. A multivariate analysis demonstrated that a 1 SD increase in fasting PG corresponded to a hazard ratio of 1.02 in men and 1.52 in women. Similarly, a 1 SD increase in 2 h PG corresponded to a hazard ratio of 1.21 in men and 1.31 in women. Waist circumference and triglyceride levels did not significantly affect risk prediction.

The authors conclude that for individuals without a previous diagnosis of diabetes mellitus, an elevated 2 h PG level is the best predictor of stroke mortality in men, whereas an elevated fasting PG level is the best predictor in women.