Prediabetes in Patients with Stroke or Transient Ischemic Attack: Prevalence, Risk and Clinical Management

Abstract

Background: The prevalence of diabetes is emerging worldwide and is an important modifiable risk factor for stroke. People with prediabetes, an intermediate metabolic state between normal glucose metabolism and diabetes, have a tenfold increased risk of developing diabetes compared to those with a normal glucose metabolism. Prediabetes is comprised of impaired fasting glucose and/or impaired glucose tolerance and/or disturbed glycosylated hemoglobin levels. Prediabetes is highly prevalent in nondiabetic patients with transient ischemic attack (TIA) or ischemic stroke and nearly doubles their risk of stroke. This offers new options for secondary stroke prevention. Summary: Several detection methods exist for identifying (pre)diabetes, including fasting plasma glucose, 2-hour postload glucose and glycosylated hemoglobin levels. The concordance between these tests is not 100%, and they seem to be complementary. Screening for (pre)diabetes after stroke with fasting plasma glucose levels alone is insufficient, and 2-hour postload glucose and/or glycosylated hemoglobin levels should be determined as well. The prevalence of prediabetes in previously nondiabetic patients with a recent TIA or stroke ranges from 23 to 53%. This high prevalence in the acute phase after stroke can be transient or persistent, representing undiagnosed abnormal glucose metabolism. Impaired fasting glucose and impaired glucose tolerance have different pathophysiological mechanisms, including hepatic insulin resistance and muscle insulin resistance, respectively. Prediabetes seems to be a modest predictor for stroke, but doubles the risk for recurrent stroke. The relation between prediabetes after stroke and functional outcome is still unknown. However, it is most likely that prediabetes is a risk factor for a poor clinical outcome after stroke. There is a growing recognition that patients with prediabetes should be treated more aggressively. Both lifestyle and pharmacological interventions are possible treatment strategies. They are at least equally effective in preventing progression to diabetes. Lifestyle changes are difficult to maintain over a long period. The evidence of pharmacological interventions on stroke or other cardiovascular diseases is limited though and is still subject of several clinical trials. Conclusions: As the prevalence of prediabetes is growing rapidly, prediabetes might become one of the most important modifiable therapeutic targets in both primary and secondary prevention.

Impact of prediabetes on poststroke depression in Chinese patients with acute ischemic stroke

“…preDM has also been considered as a vascular risk factor for stroke and cardiovascular diseases . The prevalence of preDM in patients with acute ischemic stroke as presented in our study (48.8%) was nearly similar to the findings presented in previous studies (average of 37%) . The prevalence of type 2 diabetes and preDM increased sharply in recent years, especially in Asia .…”

“…DM and preDM are various stages of abnormal glucose metabolism. Patients diagnosed with preDM are at a relatively high risk for the development of type 2 diabetes in the future . DM is a strong risk factor for acute ischemic stroke .…”

“…Patients with preDM have a relatively high risk of developing type 2 diabetes in the future . Moreover, preDM is highly prevalent (37%) in nondiabetic patients who suffered a recent transient ischemic attack (TIA) or ischemic stroke and increases the risk of both stroke and recurrent stroke . Previous studies have suggested that diabetes and preDM are risk factors for a poor clinical outcome after stroke .…”

Treatment with Clopidogrel Prior to Acute Non-Cardioembolic Ischemic Stroke Attenuates Stroke Severity

“…However, patients who were on clopidogrel had higher prevalence of T2DM and prior stroke, which are associated with worse functional outcome [38][39][40][41][42][43][44] . Therefore, it is possible that clopidogrel might have a beneficial effect on the functional outcome of ischemic stroke.…”

Recurrent Stroke in Minor Ischemic Stroke or Transient Ischemic Attack With Metabolic Syndrome and/or Diabetes Mellitus

“…2,3 Among these factors, abnormal glucose regulation was an established risk factors of recurrent stroke in patients with stroke or TIA. 24 The physiology underlying the elevated risk of recurrent ischemic stroke in diabetic METS may be that it was a recognized risk factor of intracranial atherosclerosis. 25,26 Previous studies also reported that diabetic METS was associated with recurrent ischemic stroke in patients with large-vessel infarction or lacunar stroke, 10,17 which we were not able to examine in our study.…”