Research Paper Volume 13, Issue 6 pp 9108—9118

Stress hyperglycemia may have higher risk of stroke recurrence than previously diagnosed diabetes mellitus

Yuzhou Guo1,2,3,4,5, *, , Guangyao Wang1,2,3,4, *, , Jing Jing1,2,3,4, , Anxin Wang1,2,3,4, , Xiaoli Zhang1,2,3,4, , Xia Meng1,2,3,4, , Xingquan Zhao1,2,3,4, , Liping Liu1,2,3,4, , Hao Li1,2,3,4, , David Wang6, , Yongjun Wang1,2,3,4, , Yilong Wang1,2,3,4, ,

  • 1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  • 2 China National Clinical Research Center for Neurological Diseases, Beijing, China
  • 3 Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
  • 4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
  • 5 Department of Neurology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
  • 6 Neurovascular Division, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
* Co-first authors

Received: August 27, 2020       Accepted: November 25, 2020       Published: March 22, 2021
How to Cite

Copyright: © 2021 Guo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


We aim to evaluate the risk of stroke recurrence among non-diabetes mellitus (non-DM), previously diagnosed diabetes mellitus (PDDM), newly diagnosed diabetes mellitus-related hyperglycemia (NDDM-RH) and stress hyperglycemia after minor stroke or TIA. Totally, 3026 patients with baseline fasting glucose and glycated albumin from the CHANCE trial (Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events) were included. Patients were classified as non-DM, PDDM, NDDM-RH and stress hyperglycemia according to the status of glucose metabolism. The primary outcome was stroke recurrence during 90-day follow up. Cox regression was performed to estimate the relationship between the status of glucose metabolism and risk of 90-day stroke recurrence. Compared with PDDM, NDDM-RH had a similar risk of 90-day stroke recurrence (hazard ratios [HR]1.39, 95% confidence intervals [CI] 0.94-2.04), while stress hyperglycemia had approximately a 5.3-fold increased risk of 90-day stroke recurrence after adjusted for confounding covariates (HR 5.32, 95% CI 3.43-8.26). Parallel results were found for 90-day recurrent ischemic stroke and composite events. Compared with PDDM in minor stroke or TIA, a parallel risk of 90-day stroke recurrence were observed for NDDM-RH, while stress hyperglycemia might relate to higher risk of 90-day stroke recurrence.


NDDM-RH: newly diagnosed diabetes mellitus-related hyperglycemia; PDDM: previously diagnosed diabetes mellitus; TIA: transient ischemic attack; CHANCE: Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events; non-DM: non-diabetes mellitus; GA: glycated albumin; HR: hazard ratios; CI: confidence intervals; DM: Diabetes mellitus; NIHSS: National Institutes of Health Stroke Scale.