Association Between Hemoglobin A1C and the Severity of Acute Ischemic Stroke in Sudanese Patients in Omdurman Military Hospital

Abstract

Background: Hemoglobin A1C (HbA1c) levels are known to be linked to a higher risk of stroke. However, no research data is available on the impact of HbA1C on the severity of acute ischemic stroke in Sudan. Methods: This study is a descriptive, cross-sectional hospital-based study of 40 cases of acute ischemic stroke. Ischemic stroke was confirmed using computed tomography (CT) scan at admission; all subjects’ blood HbA1C levels were also measured. Participants were divided into two subgroups based on HbA1C at admission, good glycemic control (GGC) (<7 HbA1C) and poor glycemic control (PGC) (>7 HbA1C), and neurological impairment was assessed using the National Institutes of Health Stroke Scale (NIHSS). Results: The age distribution of the participants was 45-85 years, with an average age of 63.5±9.2 years with the highest frequency (67.5%) in the age group of 55-75 years. PGC had a statistically significant high HbA1C value of 8.9±1.3 (P=0.000), when compared to GGC subgroups 5.1±0. The association between stroke severity and HbA1C levels on admission in this study was statistically significant (P value=0.005), on admission (78.6%) PGC had moderate to severe stroke (> 18.8 NIHSS) versus (33.3%) that of the GGC (>10.4NIHSS). The frequency of elevated HbA1C levels in patients with acute ischemic stroke was 70% in this study. Conclusion: PGC was shown to be linked to the occurrence of stroke and to its severity.

ROLE OF GLYCATED HEMOGLOBIN (HbA1c) ON SEVERITY OF ISCHEMIC STROKE IN PATIENTS WITH (TYPE1AND 2) DIABETES MELLITUS

“…Glycosylated hemoglobin (HbA1c) of three levels (mild, moderate and severe) stroke categories did not show any wide range of variation as seen (9.5-8.8-9.3) respectively, thus no statically significant relation between HbA1c means and stroke severity. The results in this study were compatible with studies from USA and China [44] in contrast to other several studies [23,22]. The explanation of these disagreements may be attributable to several reason: First, the number of diabetic patients included in this study was small.…”

“…The relations between FBS, RBS mean and stroke severity was statically not significant (p>0.05). This was in harmony with the reports of Wen-Yu [43] and Chao Liu from China [25] and Omar [23], in contrast to Tao Yao et al [44] from China and Sunanda et al from India [22].…”

“…For example, studies from India [21,22] conduct to explain the effect of glycemic status at admission on severity and outcome of acute Ischemic stroke in patients with diabetes conclude that glycemic control has significant association on severity and outcome of ischemic stroke patients with diabetes and they stated that estimation of HbA1c levels at the time of admission might be a predictor of the severity of neurological impairment in patients with acute ischemic stroke and diabetes mellitus. Same findings were found by studies from Arabic countries (Sudan [23] and Egypt [24]). while other studies (China [25] and Korea [26] conclude that no association was detected between HbA1c with stroke severity.…”

“…The hypertensive patients in this study were distributed according to the stroke severity categories as (37.3% in moderate severity and 12% in severe category, mean NIHSS score of hypertensives was comparable higher than non-hypertensive patients (11.60 vs. 10.78 respectively. This did not reveal any statical significant differences between hypertension and stroke severity (p=0.48), that was similarly reported by Sivaji et al from India [21] and Omar et al from Sudan [23]. However, hypertension had a significant association with stroke severity in several studies [41,42], which could be explained by the fact that the reason for this discrepancy may be related to small sample size.…”

“…The majority of poor glycemic control group (66.7%) had moderate to severe stroke (NIHSS >8) when compared to (75%) in good glycemic control during the period of admission. The stroke severity did not show any statistical significance (p =0.84) values among glycemic control groups of patients which was corresponding to the reports of Sung et al from Korea [26] and Chao Liu from China [25], but not comparable to studies from Sudan [23] and India [22].…”