Pre-diabetes is a predictor of short-term poor outcomes after acute ischemic stroke using IV thrombolysis

Kim, Byoung-Gwon; Kim, Ga Yeon; Cha, Jae‐Kwan

doi:10.1186/s12883-021-02102-1

Cited by 8 publications

(10 citation statements)

References 32 publications

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“…In accordance with previous studies, this study con rmed the deleterious effect of abnormal glucose metabolism on poor prognosis and early neurological outcomes [5,12]. Compared with normal glycemic, prediabetes and diabetic with poor PGC appears to be two high risk states of abnormal glucose metabolism.…”

Section: Discussionsupporting

confidence: 91%

“…Metabolic factors such as hyperglycemia and DM have been identi ed as contributing factors for END [9,11]. Several studies have reported a signi cant correlation between disturbed glucose metabolism and early END [5,12], however, inconsistent conclusions exist regarding which AGM status increases the risk of END. The discrepancy among studies may be due to different diagnostic criteria for identifying pre-diabetes.…”

Section: Introductionmentioning

confidence: 99%

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Impact of abnormal glucose metabolism on the early neurological outcome in acute ischemic stroke patients treated with intravenous thrombolysis

Hu¹,

Wang

Liu³

et al. 2022

Preprint

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Background and purpose: Abnormal glucose metabolism status (AGM), including prediabetes and diabetes mellitus (DM) have been reported to be an important predictor of poor functional outcome in patients experiencing acute ischemic stroke (AIS). However, conclusions of recent studies are inconsistent about which AGM status increases the risk of post-thrombolysis early neurological deterioration (END). The purpose of this study was to evaluate the impact of AGM status on the risk of post-thrombolysis early neurological outcomes. We further investigated the influence of previous glucose control of diabetic patients on the post-thrombolysis early neurological outcomes evaluation. Methods: Prediabetes was identified as glycosylated hemoglobin (HbAlc) (%) level within the range of 5.7%-6.4%, and diabetes mellitus (DM) was diagnosed based on prior history of diabetes or an HbAlc≥6.5% and patients with HbAlc less than 5.7% were classified as normal glucose metabolism (NGM). Diabetic patients with good PGC had HbAlc <7%, diabetic patients with poor PGC had HbAlc≥7%. END was defined as a National Institutes of Health Stroke Scale Score (NIHSS) ≥ 4, ENI was defined as a ≥4-point decrease in NIHSS score or a complete resolution of neurological deficits, between the time of admission and 24 hours after IV-rtPA. Results In total, 261 (32.7%) patients were diagnosed with prediabetes, 91 (11.4%) patients were DM had good PGC and 186 (23.3%) patients were DM had poor PGC. After adjusted for confounders, in model 1, DM with poor PGC associated with the increased risk of post-thrombolysis END and poor functional outcome at discharge (OR, 2.09; 95% CI, 1.220-3.579; P=0.007) (OR, 1.91; 95% CI, 1.165-3.133; P=0.010), both prediabetes and DM with poor PGC were less likely to experience post-thrombolysis ENI (OR, 0.58; 95% CI, 0.377-0.907; P=0.016) (OR, 0.43; 95% CI, 0.255-0.71; P=0.001); in model 2, further adjusted for admission hyperglycemia, the presence of diabetes and DM with poor PGC was still independently related to post-thrombolysis ENI (OR, 0.62; 95% CI, 0.400-0.969; P=0.036) (OR, 0.51; 95% CI, 0.282-0.923; P=0.026). Conclusion Prediabetes and DM with poor PGC might be two abnormal blood glucose metabolism states that affects post-thrombolysis early neurological outcome in AIS patients.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Impact of abnormal glucose metabolism on the early neurological outcome in acute ischemic stroke patients treated with intravenous thrombolysis

Hu¹,

Wang

Liu³

et al. 2022

Preprint

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“…In this large prospective trial in a tertiary care medical center ICCU, the prevalence of pre-DM (32.4%) and DM (28.6%) patients were similar to several other studies involving cardiac and ICCU patients [ 14 , 15 ]. Around 9% of patients with no previous diagnosis of DM had HbA1c levels on admission in the diabetic range.…”

Section: Discussionsupporting

confidence: 86%

“…However, several other trials have shown similar findings with regard to the short-term prognosis, among a diverse group of patients. Kim et al have found that pre-DM condition, unlike DM, was a significant predictor of short-term neurological outcomes and in-hospital mortality among patients with acute ischemic stroke [ 15 ] . It should be mentioned that in this study, the initial glucose measurement was higher in the DM group as compared with the pre-DM and normoglycemic groups.…”

Section: Discussionmentioning

confidence: 99%

Hemoglobin A1C as a prognostic factor and the pre-diabetic paradox in patients admitted to a tertiary care medical center intensive cardiac care unit

Lupu

Taha

Farkash

et al. 2022

Cardiovasc Diabetol

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Background Hemoglobin A1C (HbA1c) is a form of glycated hemoglobin used to estimate glycemic control in diabetic patients. Data regarding the prognostic significance of HbA1c levels in contemporary intensive cardiac care unit (ICCU) patients is limited. Methods All patients admitted to the ICCU at a tertiary care medical center between January 1, 2020, and June 30, 2021, with documented admission HbA1c levels were included in the study. Patients were divided into 3 groups according to their HbA1c levels: < 5.7 g% [no diabetes mellitus (DM)], 5.7–6.4 g% (pre-DM), ≥ 6.5 g% (DM). Results A total of 1412 patients were included. Of them, 974 (69%) were male with a mean age of 67(± 15.7) years old. HbA1c level < 5.7 g% was found in 550 (39%) patients, 5.7–6.4 g% in 458 (32.4%) patients and ≥ 6.5 g% in 404 (28.6%) patients. Among patients who did not know they had DM, 81 (9.3%) patients had high HbA1c levels (≥ 6.5 g%) on admission. The crude mortality rate at follow-up (up to 1.5 years) was almost twice as high among patients with pre-DM and DM than in patients with no DM (10.6% vs. 5.4%, respectively, p = 0.01). Interestingly, although not statistically significant, the trend was that pre-DM patients had the strongest association with mortality rate [HR 1.83, (95% CI 0.936–3.588); p = 0.077]. Conclusions Although an HbA1c level of ≥ 5.7 g% (pre-DM & DM) is associated with a worse prognosis in patients admitted to ICCU, pre-DM patients, paradoxically, have the highest risk for short and long-term mortality rates.

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“…Diabetes is an independent and modifiable risk factor for stroke ( 1 ). Approximately 30% of stroke patients have diabetes, and this number is even higher when patients with pre-diabetes are considered ( 2 – 4 ). Diabetes is also linked to poor stroke outcomes including higher mortality, larger infarction, and worse long-term recovery ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

Dysregulated Hypothalamic–Pituitary–Adrenal Axis Is Associated With Increased Inflammation and Worse Outcomes After Ischemic Stroke in Diabetic Mice

et al. 2022

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Diabetic patients have larger infarcts, worse neurological deficits, and higher mortality rate after an ischemic stroke. Evidence shows that in diabetes, the hypothalamic–pituitary–adrenal (HPA) axis was dysregulated and levels of cortisol increased. Based on the role of the HPA axis in immunity, we hypothesized that diabetes-dysregulated stress response exacerbates stroke outcomes via regulation of inflammation. To test this hypothesis, we assessed the regulation of the HPA axis in diabetic mice before and after stroke and determined its relevance in the regulation of post-stroke injury and inflammation. Diabetes was induced in C57BL/6 mice by feeding a high-fat diet and intraperitoneal injection of streptozotocin (STZ), and then the mice were subjected to 30 min of middle cerebral artery occlusion (MCAO). Infarct volume and neurological scores were measured in the ischemic mice. The inflammatory cytokine and chemokine levels were also determined in the ischemic brain. To assess the effect of diabetes on the stroke-modulated HPA axis, we measured the expression of components in the HPA axis including corticotropin-releasing hormone (CRH) in the hypothalamus, proopiomelanocortin (POMC) in the pituitary, and plasma adrenocorticotropic hormone (ACTH) and corticosterone. Diabetic mice had larger infarcts and worse neurological scores after stroke. The exacerbated stroke outcomes in diabetic mice were accompanied by the upregulated expression of inflammatory factors (including IL-1β, TNF-α, IL-6, CCR2, and MCP-1) in the ischemic brain. We also confirmed increased levels of hypothalamic CRH, pituitary POMC, and plasma corticosterone in diabetic mice before and after stroke, suggesting the hyper-activated HPA axis in diabetic conditions. Finally, we confirmed that post-stroke treatment of metyrapone (an inhibitor of glucocorticoid synthesis) reduced IL-6 expression and the infarct size in the ischemic brain of diabetic mice. These results elucidate the mechanisms in which the HPA axis in diabetes exacerbates ischemic stroke. Maintaining an optimal level of the stress response by regulating the HPA axis may be an effective approach to improving stroke outcomes in patients with diabetes.

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Pre-diabetes is a predictor of short-term poor outcomes after acute ischemic stroke using IV thrombolysis

Cited by 8 publications

References 32 publications

Impact of abnormal glucose metabolism on the early neurological outcome in acute ischemic stroke patients treated with intravenous thrombolysis

Impact of abnormal glucose metabolism on the early neurological outcome in acute ischemic stroke patients treated with intravenous thrombolysis

Hemoglobin A1C as a prognostic factor and the pre-diabetic paradox in patients admitted to a tertiary care medical center intensive cardiac care unit

Dysregulated Hypothalamic–Pituitary–Adrenal Axis Is Associated With Increased Inflammation and Worse Outcomes After Ischemic Stroke in Diabetic Mice

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