Association Between Diabetes and Stroke Subtype on Survival and Functional Outcome 3 Months After Stroke

Megherbi, Salah-Eddine; Milan, Chantal; Minier, Dominique; Couvreur, G.; Osseby, Guy‐Victor; Tilling, Kate; Carlo, Antonio Di; Inzitari, Domenico; Wolfe, Charles D.A.; Moreau, Thibault; Giroud, Maurice

doi:10.1161/01.str.0000057975.15221.40

Cited by 321 publications

(258 citation statements)

References 23 publications

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“…Stroke outcomes are worse in patients with diabetes 1, 2. This is likely due to hyperglycemia, which is considered a poor prognostic factor in stroke patients 3, 4.…”

Section: Introductionmentioning

confidence: 99%

Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post‐Thrombolysis: Findings From Get With The Guidelines‐Stroke

Masrur

Cox

Bhatt

et al. 2015

JAHA

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BackgroundHyperglycemia has been associated with adverse outcomes in patients with acute ischemic stroke (AIS) and may influence outcomes after tissue plasminogen activator (tPA). We sought to analyze the association of acute and chronic hyperglycemia on clinical outcomes in tPA‐treated patients.Methods and ResultsWe identified 58 265 AIS patients from 1408 sites who received tPA from 2009 to 2013 in Get With The Guidelines‐Stroke. Acute hyperglycemia at admission was defined as a plasma glucose level >140 mg/dL. Chronic hyperglycemia was defined by plasma glycosylated hemoglobin (HbA1c) >6.5%. Post‐tPA outcomes were analyzed using logistic regression. Blood glucose >140 mg/dL and HbA1c >6.5 were associated with worse clinical outcomes (symptomatic intracranial hemorrhage [sICH], life‐threatening hemorrhage, and in‐hospital mortality and length of stay) in diabetic and nondiabetic patients. Among patients with documented history of diabetes, increasing admission glucose up to 200 mg/dL was associated with increased adjusted odds ratio (aOR) of in‐hospital mortality (aOR, 1.07) and sICH (aOR, 1.05) per 10 mg/dL increase in blood glucose. Increasing HbA1C to 8% was associated with increased odds of in‐hospital mortality (aOR, 1.19) and sICH (aOR, 1.16) per 1% increase in HbA1c. Similar findings were observed in patients without a documented history of diabetes. There was no further increase in poor outcomes above the blood glucose level of 200 mg/dL or HbA1c >8.ConclusionAcute and chronic hyperglycemia are both associated with increased mortality and worse clinical outcomes in AIS patients treated with tPA. Controlled trials are needed to determine whether acute correction of hyperglycemia can improve outcomes after thrombolysis.

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“…Stroke outcomes are worse in patients with diabetes 1, 2. This is likely due to hyperglycemia, which is considered a poor prognostic factor in stroke patients 3, 4.…”

Section: Introductionmentioning

confidence: 99%

Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post‐Thrombolysis: Findings From Get With The Guidelines‐Stroke

Masrur

Cox

Bhatt

et al. 2015

JAHA

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show abstract

“…Diabetes is an important risk factor for myocardial infarction and stroke, and has an unfavourable influence on recovery after stroke [1]. Even in patients without diabetes, admission hyperglycaemia in cases of acute ischaemic stroke is associated with a worse functional outcome, longer hospital stay and higher risk of death within 30 days according to a recent systematic review [2].…”

Section: Introductionmentioning

confidence: 99%

Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study

et al. 2009

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Aims/hypothesis Admission hyperglycaemia is associated with a poor outcome in patients with ischaemic stroke. However, its prognostic effects after intracerebral haemorrhage (ICH) are still unclear. Methods We prospectively enrolled patients with ICH at 33 centres in Korea between October 2002 and March 2004. A total of 1,387 patients who had ICH and underwent brain computed tomography within 48 h of symptom onset were included in the study (n=1,387). Clinical information and radiological findings were collected at admission. Glucose levels were examined in relation to early (up to 30 days after ictus) and long-term (after 30 days) mortality rates using Cox regression analysis. To eliminate short-term effects, long-term mortality rate analysis was performed on surviving patients for more than 30 days. Results The long-term mortality rate was 21.1% after a mean follow-up of 434.3±223.2 days and was found to increase significantly with glucose quartile (p<0.001). Admission glucose level was an independent risk factor for early mortality (per mmol/l; adjusted HR 1.10 [95% CI 1.01-1.19]), but not for long-term mortality. Moreover, when analysis was restricted to patients without diabetes, glucose level was found to be an independent risk factor for post-ICH mortality (n=1,119; adjusted HR 1.10 [95% CI 1.03-1.17]) and had marginal significance for early (p= 0.053) and long-term mortality (p=0.09). Conclusions/interpretation We found that admission glucose levels were associated with early mortality after ICH. In patients without diabetes, admission glucose levels were associated with long-term mortality. We therefore suggest that intensive lowering of glucose level should be further investigated in ICH patients.

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“…Diabetes is associated with poor functional outcome after ischemic stroke (odds ratio [OR] 1.5, 95% CI 1.1–1.9)98, and with an increased mortality 1 year after ischemic stroke (HR 1.2, 95% CI 1.1–1.2)99. Diabetes also increases the risk of post‐stroke dementia (OR 1.4, 95% CI 1.2–1.7)100.…”

Section: Type 2 Diabetes Mellitus Stroke and Incretin‐based Therapiesmentioning

confidence: 99%

Potentials of incretin‐based therapies in dementia and stroke in type 2 diabetes mellitus

Groeneveld

Kappelle

Biessels

2015

J of Diabetes Invest

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Patients with type 2 diabetes mellitus are at risk for accelerated cognitive decline and dementia. Furthermore, their risk of stroke is increased and their outcome after stroke is worse than in those without diabetes. Incretin‐based therapies are a class of antidiabetic agents that are of interest in relation to these cerebral complications of diabetes. Two classes of incretin‐based therapies are currently available: the glucagon‐like‐peptide‐1 agonists and the dipeptidyl peptidase‐4 ‐inhibitors. Independent of their glucose‐lowering effects, incretin‐based therapies might also have direct or indirect beneficial effects on the brain. In the present review, we discuss the potential of incretin‐based therapies in relation to dementia, in particular Alzheimer's disease, and stroke in patients with type 2 diabetes. Experimental studies on Alzheimer's disease have found beneficial effects of incretin‐based therapies on cognition, synaptic plasticity and metabolism of amyloid‐β and microtubule‐associated protein tau. Preclinical studies on incretin‐based therapies in stroke have shown an improved functional outcome, a reduction of infarct volume as well as neuroprotective and neurotrophic properties. Both with regard to the treatment of Alzheimer's disease, and with regard to prevention and treatment of stroke, randomized controlled trials in patients with or without diabetes are underway. In conclusion, experimental studies show promising results of incretin‐based therapies at improving the outcome of Alzheimer's disease and stroke through glucose‐independent pleiotropic effects on the brain. If these findings would indeed be confirmed in large clinical randomized controlled trials, this would have substantial impact.

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Association Between Diabetes and Stroke Subtype on Survival and Functional Outcome 3 Months After Stroke

Cited by 321 publications

References 23 publications

Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post‐Thrombolysis: Findings From Get With The Guidelines‐Stroke

Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post‐Thrombolysis: Findings From Get With The Guidelines‐Stroke

Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study

Potentials of incretin‐based therapies in dementia and stroke in type 2 diabetes mellitus

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