SWEET-FIX: a quality improvement initiative for hospitalized stroke patients with undiagnosed diabetes or prediabetes.

The consequences of type-2 diabetes can be devastating and include a high risk for incident stroke. Fortunately, appropriate and timely treatment of diabetes may avert future complications and improve clinical outcomes. However, it would appear that up to 25% of the general population in the United States with diabetes may be undiagnosed, thereby exposing these individuals to the relentlessly progressive and unmitigated effects of diabetes on the systemic vasculature, with resultant major end-organ damage. Coordinated identification of underlying diabetes especially in persons with prevalent symptomatic vascular disease, could help target patients at very high vascular risk, who may benefit from evidence-based optimal glycemic control and more aggressive multimodal vascular risk reduction. The inpatient setting could represent a window of opportunity to screen and appropriately manage patients hospitalized with recent symptomatic cerebral ischemia who harbor undiagnosed diabetes. Preliminary data suggest that up to 10% of hospitalized ischemic stroke and transient ischemic attack patients may have undiagnosed diabetes or prediabetes. Aiming to enhance in-hospital stroke care and improve target biomarker control, the SWift Evaluation and Early Treatment to Favorably Impact Inconspicuous glucose eXcess (SWEET-FIX) program, is being implemented at the University of California, Los Angeles Medial Center to systematically screen ischemic stroke and transient ischemic attack patients for undiagnosed diabetes or prediabetes, then implement evidence-based drug and behavioral goals prior to hospital discharge.