Association between fasting blood glucose levels and stroke events: a large-scale community-based cohort study from China

Zhang, Ya Ping; Gu, Shujun; Wang, Cuicui; Liu, Dong; Zhang, Qiuyi; Yang, Man; Zhou, Zhengyuan; Zuo, Hui

doi:10.1136/bmjopen-2021-050234

Cited by 12 publications

(9 citation statements)

References 46 publications

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“…A study from Brazil found a significant association of health literacy with HbA1c and glycemic control [ 33 ]. A study in China also found that higher FBG levels were associated with an increased risk of complications, such as stroke [ 45 ]. Health literacy not only limits the ability to read but also the adherence to medical advice.…”

Section: Discussionmentioning

confidence: 99%

Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities

et al. 2023

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Background Properly understanding the health information of people with type 2 diabetes mellitus (T2DM) is the basis for better risk factor management, which also positively affects their quality of life. The aim of this study was to investigate diabetes health literacy (HL), self-efficacy, and self-care behaviors associated with glycemic control among older adults with T2DM in northern Thai communities. Methods A cross-sectional study was conducted among 414 older adults over the age of 60 diagnosed with T2DM. The study was conducted in Phayao Province from January to May 2022. Simple random sampling of the patient list for the Java Health Center Information System program was used. Questionnaires were used to collect data on diabetes HL, self-efficacy, and self-care behaviors. Blood samples were tested for estimated glomerular filtration rate (eGFR) and glycemic controls, such as fasting blood sugar (FBS) and glycated hemoglobin (HbA1c). Results The mean age of participants was 67.1 years. FBS (mean ± SD = 108.5 ± 29.5 mg/dL) and HbA1c (mean ± SD = 6.6 ± 1.2%) levels were found to be abnormal in 50.5% (≥ 126 mg/dL) and 17.4% (≥ 6.5%) of the subjects, respectively. There was a strong correlation between HL and self-efficacy (r = 0.78), HL and self-care behaviors (r = 0.76), and self-efficacy and self-care behaviors (r = 0.84). The eGFR was significantly correlated with diabetes HL (r = 0.23), self-efficacy (r = 0.14), self-care behaviors (r = 0.16), and HbA1c (r = -0.16) scores. Linear regression after adjusting for sex, age, education, DM duration, smoking, and drinking alcohol showed that FBS level was inversely associated with diabetes HL (Beta = -0.21, R2 = 11.0%), self-efficacy (Beta = -0.43, R2 = 22.2%), and self-care behavior (Beta = -0.35, R2 = 17.8%), whereas HbA1C level was negatively associated with diabetes HL (Beta = -0.52, R2 = 23.8%), self-efficacy (Beta = -0.39, R2 = 19.1%), and self-care behavior (Beta = -0.42, R2 = 20.7%). Conclusion Diabetes HL was related to self-efficacy and self-care behaviors in elderly T2DM patients and was shown to influence their health, including glycemic control. These findings suggest that implementing HL programs to build competence in self-efficacy expectations is important for contributing to improvements in diabetes preventive care behaviors and HbA1c control.

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Section: Discussionmentioning

confidence: 99%

Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities

et al. 2023

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“…The within-day and between-day coefficients of variation were 0.70–3.50% (tryptophan: 1.85%, tyrosine: 3.50%, valine: 0.70%, phenylalanine: 1.70%, leucine: 1.40%, isoleucine: 1.25%, and cotinine: 2.47%) and 2.45–17.3% (tryptophan: 4.81%, tyrosine: 4.65%, valine: 3.70%, phenylalanine: 4.88%, leucine: 2.68%, isoleucine: 17.3%, and cotinine: 2.45%), respectively. Serum glucose levels were determined using the oxidase enzymatic method; creatinine was measured via the picric acid method; and total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) were assessed using enzymatic methods [ 22 , 23 ].…”

Section: Methodsmentioning

confidence: 99%

The Tryptophan Index Is Associated with Risk of Ischemic Stroke: A Community-Based Nested Case–Control Study

Liu,

Hong,

Chen

et al. 2024

Nutrients

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Background: The relative availability of the essential amino acid tryptophan in the brain, as indicated by the tryptophan index, which is the ratio of tryptophan to its competing amino acids (CAAs) in circulation, has been related to major depression. However, it remains unknown whether tryptophan availability is involved in the pathogenesis of ischemic stroke. Aims: We aimed to investigate the relationship between the tryptophan index and the risk of ischemic stroke. Methods: We performed a nested case–control study within a community-based cohort in eastern China over the period 2013 to 2018. The analysis included 321 cases of ischemic stroke and 321 controls matched by sex and date of birth. The plasma levels of tryptophan and CAAs, including tyrosine, valine, phenylalanine, leucine, and isoleucine, were measured by ultra-high-performance liquid chromatography–tandem mass spectrometry. Conditional logistic regression analyses were employed to determine incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). Results: After adjustment for body mass index, current smoking status, educational attainment, physical activity, family history of stroke, hypertension, diabetes, hyperlipidemia, and estimated glomerular filtration rate, an elevated tryptophan index was significantly associated with a reduced risk of ischemic stroke in a dose–response manner (IRR, 0.76; 95% CI, 0.63–0.93, per standard deviation increment). The plasma tryptophan or CAAs were not separately associated with the risk of ischemic stroke. Conclusions: The tryptophan index was inversely associated with the risk of ischemic stroke. Our novel observations suggest that the availability of the essential amino acid tryptophan in the brain is involved in the pathogenesis of ischemic stroke.

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“…Receiver operator characteristic (ROC) curves were used to calculate the predictive values of SHR, FPG, and RPG as both continuous and binary variables for predicting moderate-to-severe CED, poor functional outcome, and death at 90 days in the training cohort and validation cohort. As a binary variable, FPG was dichotomized to ≥ 7 mmol/L and < 7 mmol/L and RPG was dichotomized to ≥ 10 mmol/L and < 10 mmol/L based on previous studies ( Zhang et al, 2021 ; Mac Grory et al, 2022 ). For the SHR, the ROC curve in the training cohort was applied to identify an optimized cutoff value (the maximum value of the Youden index) of the SHR to predict the onset of moderate-to-severe CED.…”

Section: Methodsmentioning

confidence: 99%

The stress hyperglycemia ratio is associated with the development of cerebral edema and poor functional outcome in patients with acute cerebral infarction

Deng

Liu

et al. 2022

Front. Aging Neurosci.

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Background and purposeAbsolute hyperglycemia at admission has been shown to be associated with the development of cerebral edema (CED) after acute cerebral infarction. Stress hyperglycemia is a more objective reflection of hyperglycemic state than absolute hyperglycemia. However, studies on the associations between stress hyperglycemia and CED are limited. We aimed to explore the associations of stress hyperglycemia, measured by stress hyperglycemia ratio (SHR), with the development of CED and poor functional outcome of acute cerebral infarction.MethodsPatients with acute middle artery cerebral infarction admitted to the Department of Neurology, West China Hospital of Sichuan University, within 24 h of symptom onset from January 2017 to March 2021 were included. Stress hyperglycemia was assessed by the SHR: admission fasting plasma glucose (FPG)/hemoglobin A1c (HbA1c). The primary outcome was the degree of CED evaluated on brain image. The secondary outcomes were moderate-to-severe CED, poor functional outcome (modified Rankin Scale score > 2), and death at 90 days. The associations between the SHR and outcomes were assessed with multivariate logistic regression analyses. We further compared the predictive value of the SHR, admission random plasma glucose (RPG), and admission FPG for outcomes in the training dataset and validation dataset.Results638 patients were enrolled. Each 0.1-point increase in the SHR was independently associated with a 1.31-fold increased risk of a higher degree of CED [odds ratio (OR): 1.31 (95% confidence interval (CI): 1.20–1.42), P < 0.001]. The SHR was independently associated with moderate-to-severe CED [per 0.1-point increase: OR: 1.39 (95% CI: 1.24–1.57), P < 0.001], poor functional outcome [per 0.1-point increase: OR: 1.25 (95% CI: 1.12–1.40), P < 0.001], and death [per 0.1-point increase: OR: 1.13 (95% CI: 1.03–1.25), P < 0.05]. The predictive value of the SHR (as a continuous variable), exhibited by the area under the curve in receiver operating characteristic analysis, was higher than that of the RPG and FPG for moderate-to-severe CED and poor functional outcome (P < 0.05).ConclusionThe SHR is independently associated with the severity of CED, poor functional outcome, and death after acute cerebral infarction, and the SHR (as a continuous variable) has a better predictive value for moderate-to-severe CED and poor functional outcome than the RPG and FPG.

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Association between fasting blood glucose levels and stroke events: a large-scale community-based cohort study from China

Cited by 12 publications

References 46 publications

Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities

Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities

The Tryptophan Index Is Associated with Risk of Ischemic Stroke: A Community-Based Nested Case–Control Study

The stress hyperglycemia ratio is associated with the development of cerebral edema and poor functional outcome in patients with acute cerebral infarction

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