Risk Factor Control in Stroke Survivors with Diagnosed and Undiagnosed Diabetes: A Ghanaian Registry Analysis

Expert consensus guidelines recommend optimizing global risk factor control in diabetic stroke survivors to improve outcomes. Since relatively little is known about the adequacy of risk factor control among diabetic stroke survivors in sub-Saharan Africa, we sought to assess control rates of key traditional risk factors among Ghanaian stroke survivors with diabetes. A secondary objective was to assess the burden of undiagnosed dysglycemic states among stroke survivors without a prior diagnosis of diabetes mellitus (DM) METHODS: Cross-sectional study of outpatient stroke survivors consecutively enrolled in a stroke registry at a tertiary medical center in Ghana between January 2018 and March 2020. We collected baseline demographic and clinical details including blood pressure, lipid panel, fasting blood glucose results, medications prescribed for secondary prevention, and stroke type information. BP control target was set at <130/80 mmHg, LDL-cholesterol <2.6 mmol/l and Fasting blood glucose (FBG) <7.0 mmol/l. Factors associated with poor control of vascular risk factors were assessed using multivariate logistic regression models.

Of 1101 stroke survivors enrolled into the registry, 279 (25.3%) had a comorbid diagnosis of DM. Mean (±SD) age among the diabetic vs. non-diabetic stroke patients was 61.4 ± 12.0 years vs. 57.6 ± 14.6 years (p < 0.0001). Among the diabetic stroke patients, 61.7% had LDL-cholesterol <2.6 mmol/L, 8.2% had BP <130/80 mm Hg and 28.6% had FBG <7.0 mmol/L. Significant predictors of poor control of BP were younger age, having co-morbid DM and number of antihypertensive medication classes while poor LDL-cholesterol was associated with longer duration of stroke diagnosis. Among those without a prior diagnosis of DM, FBG analysis of 540 subjects with available data showed that 21.7% had FBG <5.7 mmol/L, 39.0% had impaired fasting blood glucose and 39.3% had FBG in the diabetes mellitus range. Patients who were older, female, or experienced an ischemic stroke trended towards being more likely to have undiagnosed DM.

Among Ghanaian diabetic stroke survivors, blood pressure and blood glucose, are especially poorly controlled. There is also a high burden of undiagnosed pre-diabetes and DM among stroke survivors substantially heightening their risk for further adverse CVD outcomes.