Association between prediabetes and poor outcome of acute ischemic stroke_West China Medical Journal

Authors：

 ZHAO Xuebin , ZHANG Canfei

Department of Neurology, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471000, P. R. China;

Corresponding author：

ZHAO Xuebin, Email: 284953310@qq.com

Keywords：

Prediabetes; Diabetes; First-ever acute ischemic stroke; Outcome

DOI：

10.7507/1002-0179.202004457

Video：

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Objective To explore the association between prediabetes and poor outcome in patients with acute ischemic stroke (AIS).Methods The patients with first-ever AIS who were hospitalized in the Department of Neurology, the First Affiliated Hospital of Henan University of Science and Technology from September to December 2018 were retrospectively enrolled. According to the different levels of hemoglobin A1c, the patients were divided into prediabetes group, diabetes mellitus (DM) group and non-DM group. The outcome of the patients 3 months after the discharge was assessed by the modified Rankin Scale and dichotomized as good and poor outcomes. Results A total of 188 patients were included, and 160 were eventually included. Among them, 66 cases were in the non-DM group, 39 were in the prediabetes group, and 55 were in the DM group; 68 patients were in the poor prognosis group and 92 were in the good prognosis group. There was no statistically significant difference among the non-DM group, prediabetes group, and DM group (P>0.05) except for hyperlipidemia (χ²=7.781, P=0.020), triglyceride (TG) (F=8.220, P<0.001) and admission blood glucose (F=44.356, P<0.001). There was no statistically significant difference between the good prognosis group and the poor prognosis group (P>0.05) except for hyperlipidemia (χ²=4.847, P=0.028), admission blood glucose (t=−2.940, P=0.004), TG (t=−2.766, P=0.006), and NIHSS (Z=−6.038, P<0.001). Prediabetic [odds ratio (OR)=4.053, 95% confidence interval (CI) (1.491, 11.019)] and diabetic [OR=5.986, 95%CI (2.330, 15.379)] patients had a worse prognosis 3 months after the discharge.Conclusion In adults with first-ever AIS, prediabetes and diabetes were associated with poor prognosis in patients with AIS after 3 months.

Citation： ZHAO Xuebin, ZHANG Canfei. Association between prediabetes and poor outcome of acute ischemic stroke. West China Medical Journal, 2020, 35(6): 658-663. doi: 10.7507/1002-0179.202004457 Copy

1.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2014. 中华神经科杂志, 2015, 48(4): 246-257.
2.	Gray CS, Scott JF, French JM, et al. Prevalence and prediction of unrecognised diabetes mellitus and impaired glucose tolerance following acute stroke. Age Ageing, 2004, 33(1): 71-77.
3.	Zahra F, Kidwai SS, Siddiqi SA, et al. Frequency of newly diagnosed diabetes mellitus in acute ischaemic stroke patients. J Coll Physicians Surg Pak, 2012, 22(4): 226-229.
4.	International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care, 2009, 32(7): 1327-1334.
5.	Roquer J, Rodríguez-Campello A, Cuadrado-Godia E, et al. Ischemic stroke in prediabetic patients. J Neurol, 2014, 261(10): 1866-1870.
6.	Jing J, Pan Y, Zhao X, et al. Prognosis of ischemic stroke with newly diagnosed diabetes mellitus according to hemoglobin a1c criteria in Chinese population. Stroke, 2016, 47(8): 2038-2044.
7.	Wu S, Shi Y, Wang C, et al. Glycated hemoglobin independently predicts stroke recurrence within one year after acute first-ever non-cardioembolic strokes onset in a Chinese cohort study. PLoS One, 2013, 8(11): e80690.
8.	Buysschaert M, Bergman M. Definition of prediabetes. Med Clin North Am, 2011, 95(2): 289-297, vii.
9.	Levitzky YS, Pencina MJ, D'Agostino RB, et al. Impact of impaired fasting glucose on cardiovascular disease: the framingham heart study. J Am Coll Cardiol, 2008, 51(3): 264-270.
10.	Kim NH, Kwon TY, Yu S, et al. Increased vascular disease mortality risk in prediabetic korean adults is mainly attributable to ischemic stroke. Stroke, 2017, 48(4): 840-845.
11.	American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care, 2014, 37(Suppl 1): S81-S90.
12.	Pan Y, Jing J, Chen W, et al. Post-glucose load measures of insulin resistance and prognosis of nondiabetic patients with ischemic stroke. J Am Heart Assoc, 2017, 6(1): e004990.
13.	Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke, 1989, 20(7): 864-870.
14.	Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke, 1993, 24(1): 35-41.
15.	Colagiuri S. Epidemiology of prediabetes. Med Clin North Am, 2011, 95(2): 299-307, vii.
16.	Jia Q, Zheng H, Zhao X, et al. Abnormal glucose regulation in patients with acute stroke across China: prevalence and baseline patient characteristics. Stroke, 2012, 43(3): 650-657.
17.	Saxena A, Anderson CS, Wang X, et al. Prognostic significance of hyperglycemia in acute intracerebral hemorrhage: the INTERACT2 Study. Stroke, 2016, 47(3): 682-688.
18.	Snarska KK, Bachórzewska-Gajewska H, Kapica-Topczewska K, et al. Hyperglycemia and diabetes have different impacts on outcome of ischemic and hemorrhagic stroke. Arch Med Sci, 2017, 13(1): 100-108.
19.	Pan Y, Cai X, Jing J, et al. Stress hyperglycemia and prognosis of minor ischemic stroke and transient ischemic attack: the CHANCE study (clopidogrel in high-risk patients with acute nondisabling cerebrovascular events). Stroke, 2017, 48(11): 3006-3011.
20.	Luitse MJ, Velthuis BK, Kappelle LJ, et al. Chronic hyperglycemia is related to poor functional outcome after acute ischemic stroke. Int J Stroke, 2017, 12(2): 180-186.
21.	Lei C, Wu B, Liu M, et al. Association between hemoglobin A1C levels and clinical outcome in ischemic stroke patients with or without diabetes. J Clin Neurosci, 2015, 22(3): 498-503.
22.	Baird TA, Parsons MW, Phan T, et al. Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke, 2003, 34(9): 2208-2214.
23.	Garg R, Chaudhuri A, Munschauer F, et al. Hyperglycemia, insulin, and acute ischemic stroke: a mechanistic justification for a trial of insulin infusion therapy. Stroke, 2006, 37(1): 267-273.
24.	Tamura Y, Araki A. Diabetes mellitus and white matter hyperintensity. Geriatr Gerontol Int, 2015, 15(Suppl 1): 34-42.
25.	Bezerra DC, Sharrett AR, Matsushita K, et al. Risk factors for lacune subtypes in the Atherosclerosis Risk in Communities (ARIC) Study. Neurology, 2012, 78(2): 102-108.
26.	Lemkes BA, Hermanides J, Devries JH, et al. Hyperglycemia: a prothrombotic factor?. J Thromb Haemost, 2010, 8(8): 1663-1669.
27.	苏量. 脑梗死早期神经功能恶化的临床特征及与血清糖化血红蛋白的相关性分析. 神经损伤与功能重建, 2017, 12(4): 354-355, 363.

1. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2014. 中华神经科杂志, 2015, 48(4): 246-257.
2. Gray CS, Scott JF, French JM, et al. Prevalence and prediction of unrecognised diabetes mellitus and impaired glucose tolerance following acute stroke. Age Ageing, 2004, 33(1): 71-77.
3. Zahra F, Kidwai SS, Siddiqi SA, et al. Frequency of newly diagnosed diabetes mellitus in acute ischaemic stroke patients. J Coll Physicians Surg Pak, 2012, 22(4): 226-229.
4. International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care, 2009, 32(7): 1327-1334.
5. Roquer J, Rodríguez-Campello A, Cuadrado-Godia E, et al. Ischemic stroke in prediabetic patients. J Neurol, 2014, 261(10): 1866-1870.
6. Jing J, Pan Y, Zhao X, et al. Prognosis of ischemic stroke with newly diagnosed diabetes mellitus according to hemoglobin a1c criteria in Chinese population. Stroke, 2016, 47(8): 2038-2044.
7. Wu S, Shi Y, Wang C, et al. Glycated hemoglobin independently predicts stroke recurrence within one year after acute first-ever non-cardioembolic strokes onset in a Chinese cohort study. PLoS One, 2013, 8(11): e80690.
8. Buysschaert M, Bergman M. Definition of prediabetes. Med Clin North Am, 2011, 95(2): 289-297, vii.
9. Levitzky YS, Pencina MJ, D'Agostino RB, et al. Impact of impaired fasting glucose on cardiovascular disease: the framingham heart study. J Am Coll Cardiol, 2008, 51(3): 264-270.
10. Kim NH, Kwon TY, Yu S, et al. Increased vascular disease mortality risk in prediabetic korean adults is mainly attributable to ischemic stroke. Stroke, 2017, 48(4): 840-845.
11. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care, 2014, 37(Suppl 1): S81-S90.
12. Pan Y, Jing J, Chen W, et al. Post-glucose load measures of insulin resistance and prognosis of nondiabetic patients with ischemic stroke. J Am Heart Assoc, 2017, 6(1): e004990.
13. Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke, 1989, 20(7): 864-870.
14. Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke, 1993, 24(1): 35-41.
15. Colagiuri S. Epidemiology of prediabetes. Med Clin North Am, 2011, 95(2): 299-307, vii.
16. Jia Q, Zheng H, Zhao X, et al. Abnormal glucose regulation in patients with acute stroke across China: prevalence and baseline patient characteristics. Stroke, 2012, 43(3): 650-657.
17. Saxena A, Anderson CS, Wang X, et al. Prognostic significance of hyperglycemia in acute intracerebral hemorrhage: the INTERACT2 Study. Stroke, 2016, 47(3): 682-688.
18. Snarska KK, Bachórzewska-Gajewska H, Kapica-Topczewska K, et al. Hyperglycemia and diabetes have different impacts on outcome of ischemic and hemorrhagic stroke. Arch Med Sci, 2017, 13(1): 100-108.
19. Pan Y, Cai X, Jing J, et al. Stress hyperglycemia and prognosis of minor ischemic stroke and transient ischemic attack: the CHANCE study (clopidogrel in high-risk patients with acute nondisabling cerebrovascular events). Stroke, 2017, 48(11): 3006-3011.
20. Luitse MJ, Velthuis BK, Kappelle LJ, et al. Chronic hyperglycemia is related to poor functional outcome after acute ischemic stroke. Int J Stroke, 2017, 12(2): 180-186.
21. Lei C, Wu B, Liu M, et al. Association between hemoglobin A1C levels and clinical outcome in ischemic stroke patients with or without diabetes. J Clin Neurosci, 2015, 22(3): 498-503.
22. Baird TA, Parsons MW, Phan T, et al. Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke, 2003, 34(9): 2208-2214.
23. Garg R, Chaudhuri A, Munschauer F, et al. Hyperglycemia, insulin, and acute ischemic stroke: a mechanistic justification for a trial of insulin infusion therapy. Stroke, 2006, 37(1): 267-273.
24. Tamura Y, Araki A. Diabetes mellitus and white matter hyperintensity. Geriatr Gerontol Int, 2015, 15(Suppl 1): 34-42.
25. Bezerra DC, Sharrett AR, Matsushita K, et al. Risk factors for lacune subtypes in the Atherosclerosis Risk in Communities (ARIC) Study. Neurology, 2012, 78(2): 102-108.
26. Lemkes BA, Hermanides J, Devries JH, et al. Hyperglycemia: a prothrombotic factor?. J Thromb Haemost, 2010, 8(8): 1663-1669.
27. 苏量. 脑梗死早期神经功能恶化的临床特征及与血清糖化血红蛋白的相关性分析. 神经损伤与功能重建, 2017, 12(4): 354-355, 363.

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