Elevated Fasting Blood Glucose Is Predictive of Poor Outcome in Non-Diabetic Stroke Patients: A Sub-Group Analysis of SMART

Abstract

BackgroundAlthough increasing evidence suggests that hyperglycemia following acute stroke adversely affects clinical outcome, whether the association between glycaemia and functional outcome varies between stroke patients with\without pre-diagnosed diabetes remains controversial. We aimed to investigate the relationship between the fasting blood glucose (FBG) and the 6-month functional outcome in a subgroup of SMART cohort and further to assess whether this association varied based on the status of pre-diagnosed diabetes.MethodsData of 2862 patients with acute ischemic stroke (629 with pre-diagnosed diabetics) enrolled from SMART cohort were analyzed. Functional outcome at 6-month post-stroke was measured by modified Rankin Scale (mRS) and categorized as favorable (mRS:0–2) or poor (mRS:3–5). Binary logistic regression model, adjusting for age, gender, educational level, history of hypertension and stroke, baseline NIHSS and treatment group, was used in the whole cohort to evaluate the association between admission FBG and functional outcome. Stratified logistic regression analyses were further performed based on the presence/absence of pre-diabetes history.ResultsIn the whole cohort, multivariable logistical regression showed that poor functional outcome was associated with elevated FBG (OR1.21 (95%CI 1.07–1.37), p = 0.002), older age (OR1.64 (95% CI1.38–1.94), p<0.001), higher NIHSS (OR2.90 (95%CI 2.52–3.33), p<0.001) and hypertension (OR1.42 (95%CI 1.13–1.98), p = 0.04). Stratified logistical regression analysis showed that the association between FBG and functional outcome remained significant only in patients without pre-diagnosed diabetes (OR1.26 (95%CI 1.03–1.55), p = 0.023), but not in those with premorbid diagnosis of diabetes (p = 0.885).ConclusionThe present results demonstrate a significant association between elevated FBG after stroke and poor functional outcome in patients without pre-diagnosed diabetes, but not in diabetics. This finding confirms the importance of glycemic control during acute phase of ischemic stroke especially in patients without pre-diagnosed diabetes. Further investigation for developing optimal strategies to control blood glucose level in hyperglycemic setting is therefore of great importance.Trial RegistrationClinicalTrials.gov NCT00664846

Prevalence of diabetes and its effects on stroke outcomes: A meta‐analysis and literature review

“…Geographically, the mean prevalence of diabetes in stroke inpatients was highest in Southeast Asian (Singapore, India, Indonesia) and East Asian countries (China, Japan, Taiwan), which were 33.5 and 32.3%, respectively, and mostly in Taiwan. The mean prevalence in studies from North America and Europe was 27.5 and 26.4%, respectively.…”

“…Stress hyperglycemia has been associated with poorer functional outcomes 15,17,40,70 and mortality 71 , irrespective of diabetes status after an acute ischemic stroke. However, more studies have found that stress hyperglycemia has been associated with infarct volume growth, early neurological deterioration (increase of ≥4 points on National Institute of Health Stroke Scale) 16 , poorer functional outcome 12,40,41,71,72 , higher mortality 32,43,46,53,73 and longer hospital stay 40 in people without a history of diabetes, including patients who underwent thrombolysis 71,[74][75][76] and mechanical thrombectomy 77 . This association remained even after adjusting for stroke severity and stroke subtype.…”

“…, India 32 , Indonesia40 ) and East Asian countries (China8,29,38,41 , Japan 16,26 , Taiwan 11,42-44 ), which were 33.5 and 32.3%, respectively, and mostly in Taiwan11,43,44 . The mean prevalence in studies from North America12,13,20,21,30,37,[45][46][47] and Europe 5,7,17,34-36,48-53 was 27.5 and 26.4%, respectively.…”

Triglyceride-glucose index linked to hospital mortality in critically ill stroke patients: an observational multicentre study on eICU database

“…[25,26] Fourthly, recent evidence has proved that triglyceride and glucose disorder are the risk factors of stroke, while the formula of TyG index is composed of triglyceride and glucose. [27,28] Lastly, IR may augment the role of modi able risk factors of stroke, such as hypertension, atrial brillation. [10] Although the present study had showed the association between TyG index and poststroke outcomes, the underlying molecular mechanisms involved in this association should be further investigated in the future study.…”

Prognostic Signification of Admission Hyperglycemia among Acute Stroke Patients in Intensive Care Units in Kinshasa, the Democratic Republic of the Congo

“…The differences in the number of deaths between studies and countries could be explained by the differences in public health response against stroke, access to health services, treatment options, population studied, sample size and study design, statistical methods and threshold used to define hyperglycemia [24]. [30] and adds insights to the relative influence of stroke severity and hyperglycemia on clinical and neurological outcomes following stroke occurrence [31]. Even though most studies have shown that hyperglycemia at admission confers a worse prognosis following acute stroke, it is still unclear whether it only reflects stroke severity or it is directly associated with outcomes [2] [32].…”