Higher fasting glucose ups post-stroke mortality in Chinese diabetic patients
A hospital-based observational cohort study finds an association between higher fasting blood glucose (FBG) levels and unfavourable outcomes, including death, among Chinese patients with diabetes mellitus (DM) following acute ischaemic stroke (AIS).
The study enrolled 568 diabetic patients with AIS (median age, 65 years; male, 66 percent). A total of 226 patients (39.8 percent) had unfavourable outcomes (defined as modified Rankin Scale score of 3–6), including 58 deaths (10.2 percent). The FBG levels of patients with unfavourable functional outcomes at 90 days were significantly higher than those of patients with favourable functional outcomes (9.64 mmol/L vs 6.56 mmol/L; p<0.0001). [BMJ Open 2020;10:e037291]
Univariable regression analysis showed that unfavourable functional outcomes were significantly correlated with age, male gender, atrial fibrillation, coronary heart disease, National Institutes of Health Stroke Scale (NIHSS) score, small-vessel occlusion, and HbA1c and FBG level s(p<0.05).
Multivariable logistic regression analysis showed that age (odds ratio [OR], 1.02; 95 percent confidence interval [CI], 1.00 to 1.05; p=0.037), NIHSS score (OR, 1.42; 95 percent CI, 1.31 to 1.55; p<0.0001), small-vessel occlusion (OR, 0.24; 95 percent CI, 0.06 to 0.93; p=0.039) and FBG level (OR, 1.25; 95% CI 1.14 to 1.37; p<0.0001) were independent predictive factors of functional outcome for DM patients with AIS.
The FBG levels of 58 patients who did not survive at 90 days were significantly higher than those of surviving patients (10.41 mmol/L vs 7.10 mmol/L; p<0.0001). Multivariable Cox regression analysis revealed that atrial fibrillation (hazard ratio [HR], 2.17; 95 percent CI, 1.20 to 3.93; p=0.011), NIHSS score (HR, 1.11; 95 percent CI, 1.08 to 1.15; p<0.0001), small-vessel occlusion (HR, 0.07; 95 percent CI, 0.12 to 0.38; p=0.002), HbA1c (HR, 1.32; 95 percent CI, 1.15 to 1.51; p<0.0001) and FBG levels (HR, 1.10; 95 percent CI, 1.03 to 1.15; p=0.004) were independent predictive factors of death for DM patients who had AIS.
“We used Kaplan-Meier curves to compare the quartiles of FBG levels and time to death after hospital admission for AIS. The results showed a significantly higher risk of death in the two highest quartile groups [FBG, 7.38–10.10 mmol/L; FBG, ≥10.11 mmol/L] vs the two lowest quartile groups [FBG, ≤6.00 mmol/L; FBG, 6.01–7.37 mmol/L; p<0.0001],” reported the researchers.
“The mechanism underlying the predictive value of high blood glucose levels on functional outcomes and mortality is not fully understood. However, a high blood glucose level can affect the balance between the coagulation and fibrinolytic systems, resulting in impaired recanalization. In addition, elevated glucose level may also affect endothelium-derived nitric-oxide–mediated vasodilation, thereby reducing intracranial blood flow and reperfusion at the infarct site,” explained the researchers. [Diabetes 2006;55:1807-1812; Trends Cardiovasc Med 2009;19:256-262]