Pre-Stroke Glycemic Variability Estimated by Glycated Albumin Is Associated with Early Neurological Deterioration and Poor Functional Outcome in Prediabetic Patients with Acute Ischemic Stroke

Abstract

<b><i>Introduction:</i></b> Whether glycemic variability prior to stroke increases the risk of stroke outcomes in prediabetic patients presenting with acute ischemic stroke is still unclear. We evaluated whether pre-stroke glycemic variability, estimated by glycated albumin (GA), increased early neurological deterioration (END) and functional outcomes in prediabetic patients with acute ischemic stroke. <b><i>Methods:</i></b> A total of 215 acute ischemic stroke patients with prediabetes were evaluated. The primary outcome was END, defined as an incremental increase in the National Institutes of Health Stroke Scale score by ≥1 point in motor power or ≥2 points in the total score within the 7 days after admission. The secondary outcome was poor functional status defined by a modified Rankin Scale at 3 months. Higher GA (≥16.0%) was determined to reflect glycemic fluctuation prior to ischemic stroke. <b><i>Results:</i></b> Of the 215 prediabetic patients, 77 (35.8%) were in the higher GA group. In prediabetic patients, END occurrence and poor functional status were higher in the higher GA group than in the lower GA group. The multivariate analysis showed that a higher GA was associated with an increased risk of END occurrence and poor functional outcomes at 3 months (adjusted odds ratio [95% confidence interval], 4.58 [1.64–12.81], <i>p</i> = 0.004 and 2.50 [1.19–5.25], <i>p</i> = 0.02, respectively). <b><i>Conclusion:</i></b> Pre-stroke glycemic variability estimated by GA was associated with END occurrence and poor functional outcome after ischemic stroke in patients with prediabetes.

High glycemic albumin representing prestroke glycemic variability is associated with hemorrhagic transformation in patients receiving intravenous thrombolysis

“…However, the association between HbA1c and functional outcomes remains controversial 21 , 22 . In contrast, previous clinical studies on prestroke glycemic variability showed consistent results, and glycemic variability was associated with poor outcomes in stroke patients 11 , 23 . Similar to previous studies, we showed that a high GA level increased the risk of poor functional outcomes in patients treated with IVT.…”

“…Recent previous studies established that a GA level ≥ 16.0% reflected the presence of prestroke glycemic variability based on the following equation of HbA1c and GA: HbA1c = 0.216 × GA + 2.978 11 , 23 , 31 . According to this equation, we divided the subjects into two groups: a higher GA group (GA ≥ 16.0%) and a lower GA group (GA < 16.0%).…”

Glycemic control is not related to cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes

“…Also, GA has shown different impact on stroke outcomes being associated with only large artery atherosclerosis but not with small vessel occlusion and cardioembolism in diabetic individuals with acute ischemic stroke [ 30 ]. However, other study reported association of GA with early neurological deterioration in prediabetic individuals with acute ischemic stroke [ 31 ]. Reflecting short-term glycemia, FA and GA levels can be affected by acute blood glucose change, albumin turnover or metabolism [ 32 ] and therefore reflects its variability in a disease specific manner.…”

Glucose Fluctuation and Severe Internal Carotid Artery Siphon Stenosis in Type 2 Diabetes Patients

“…However, identifying factors associated with severe intracranial artery stenosis is important because patients with severe intracranial stenosis have the highest rate of recurrent stroke [ 2 , 3 ]. Furthermore, glucose fluctuation is also associated with early neurological deterioration and poor functional outcome in patients with acute ischemic stroke [ 45 ]. Interventions for glucose fluctuation can prevent intracranial artery stenosis and ischemic stroke in T2DM patients.…”