Doms № 6 -2022

The role of hyperglycemia in the course of strokes in patients with diabetes

https://doi.org/10.57105/7252-2022-6-01

Mankovsky B. M.

Key words: hyperglycemia, stroke, diabetes mellitus, acute disorders of cerebral circulation, prediction.

Abstract

Hyperglycemia is an important factor in worsening course and increasing the mortality rate in patients with acute cerebrovascular accidents, both in patients with diabetes and in people without diabetes. It was estimated that negative impact of hyperglycemia on the course of acute disorders of cerebral blood circulation can be compared with the impact of increasing of age by 20 years. There is no doubt that the post-stroke prognosis is much worse in elderly people. At the same time, the question of whether hyperglycemia independently affects the course and prognosis of a stroke (and then correcting hyperglycemia must necessarily lead to an improvement in the course of a stroke), or whether hyperglycemia is a so-called an epiphenomenon, that is, it only reflects the severity, type of stroke, localization and size of the focus of brain damage, but also does not affect the course of stroke and has no independent pathogenetic significance, does not require mandatory active correction. This literature review summarizes new data on the course of stroke in patients with diabetes.

 References  

  1. Laing SP, Swerdlow AJ, Carpenter LM et al. Mortality from cerebrovascular disease in a cohort of 23 000 patients with insulin-treated diabetes. Stroke. 2003; 34: 418-421.
  2. Janghorbani M, Hu FB, Willett WC, et al. Prospective study of type 1 and type 2 diabetes and risk of stroke subtypes: the Nurses’ Health Study. Diabetes Care. 2007; 30:1730-1735.
  3. Bell ET. A post-mortem study of vascular disease in diabetes. Arch Pathol. 1952; 53: 444-455.
  4. Aronson SM. Intracranial vascular lesions in patients with diabetes mellitus. J Neuropathol Exp Neurol. 1973; 32: 183-196.
  5. Jorgensen H, Nakayama H, Raaschou HO, Olsen TS. Stroke in patients with diabetes. The Copenhagen Stroke Study.
    1994; 25: 1977-1984.
  6. Stegmayr B, Asplund K. Diabetes as a risk factor for stroke.
    A population perspective. Diabetologia. 1995; 38: 1061-1068.
  7. Janghorbani M, Hu FB, Willett WC, et al. Prospective study of type 1 and type 2 diabetes and risk of stroke subtypes: the
    Nurses’ Health Study. Diabetes Care. 2007; 30:1730-1735.
  8. Tuttolomondo A, Pinto A, Salemi G, et al. Diabetic and non-diabetic subjects with ischemic stroke: differences, subtype distribution and outcome. Nutr Metab Cardiovasc
    2008; 18: 152-157.
  9. Horowitz DR, Tuhrim S, Weinberger JM, Rudolph SH.
    Mechanisms in lacunar infarction. Stroke. 1992; 23: 325-327.
  10. Ohira T, Shahar E, Chambless LE, et al. Risk factors for ischemic stroke subtypes: the Atherosclerosis Risk in Communities study. Stroke. 2006; 37: 2493-2498.
  11. Tuomilehto J, Rastenyte D, Jousilahti P, et al. Diabetes mellitus as a risk factor for death from stroke. Prospective study of the middle-aged Finnish population. Stroke. 1996;27: 210-215.
  12. Oliveira TV, Gorz AM, Bittencourt PR. Diabetes mellitus as a prognostic factor in ischemic cerebrovascular disease. Arq Neuropsiquiatr. 1988; 46: 287-291.
  13. Olsson T, Vitanen M, Asplund K, et al. Prognosis after stroke in diabetic patients. A controlled prospective study. Diabetologia. 1990; 33: 244-249.
  14. Wong KS. Risk factors for early death in acute ischemic stroke and intracerebral hemorrhage: A prospective hospital-based study in Asia. Asian Stroke Advisory Panel Stroke. 1999; 30: 2326-2330.
  15. Clavier I, Hommel M, Besson G, et al. Long-term prognosis of symptomatic lacunar infarcts. A hospital-based study. Stroke. 1994; 25: 2005-2009.
  16. Arboix A, Massons J, Garcia-Eroles L, et al. Diabetes is an independent risk factor for in-hospital mortality from acute spontaneous intracerebral hemorrhage. Diabetes Care. 2000; 23: 1527-1532.
  17. Johnston SC, Amarenco P, Denison H, et al. Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. N Engl J Med. 2020;383(3):207-217.
  18. Lefkovits J, Davis SM, Rossiter SC, et al. Acute stroke outcome: effects of stroke type and risk factors. Aust N Z J Med. 1992; 22: 30-35.
  19. Hier DB, Foulkes MA, Swiontoniowski M, et al. Stroke recurrence within 2 years after ischemic infarction. Stroke. 1991; 22: 155-161.
  20. Iwase M, Yamamoto M, Yoshinari M, et al. Stroke topography in diabetic and nondiabetic patients by magnetic resonance imaging. Diabetes Res Clin Pract. 1998; 42: 109-116.
  21. Toni D, De Michele M, Fiorelli M, et al. Influence of hyperglycemia on infarct size and clinical outcome of acute ischemic stroke in patients with intracranial arterial occlusion. J Neurol Sci. 1994; 123: 129-133.
  22. Mankovsky BN, Patrick JT, Metzger BE, Saver JL The size of subcortical ischemic infarction in patients with and without diabetes mellitus. Clin Neurol Neurosurg. 1996; 98: 137-141.
  23. Luchsinger JA, Tang MX, Stern Y, et al. Diabetes mellitus and risk of Alzheimer’s disease and dementia with stroke in a multiethnic cohort. Am J Epidemiol. 2001; 154: 635-641.
  24. Ouk M, Wu CY, Colby-Milley J et al. Depression and Diabetes Mellitus Multimorbidity Is Associated With Loss of Independence and Dementia Poststroke. Stroke. 2020; 51(12):3531-3540.
  25. Capes SE, Hunt D, Malmberg K, et al. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001;32(10):2426-2432.
  26. Weir CJ, Murray GD, Dyker AG, Lees KR. Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow up study. BMJ. 1997 3;314(7090):1303-1306.
  27. Williams LS, Rotich J, Qi R, et al. Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke. Neurology. 2002;59(1):67-71.
  28. Woo J, Lam CW, Kay R, et al. The influence of hyperglycemia and diabetes mellitus on immediate and 3-month morbidity and mortality after acute stroke. Arch Neurol. 1990;47(11):1174-1177.
  29. Tracey F, Crawford VL, Lawson JT, et al. Hyperglycaemia and mortality from acute stroke. Q J Med. 1993;86(7):439-446.
  30. Parsons MW, Barber PA, Desmond PM et al. Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol. 2002;52:20-28.
  31. Bell DSH, Goncalves E. Stroke in the patient with diabetes (part 1) – Epidemiology, etiology, therapy and prognosis. Diabetes Res Clin Pract. 2020;164:108193. doi: 10.1016/j. diabres.2020.108193. Epub 2020 May 20.
  32. Bell DSH, Goncalves E. Stroke in the patient with diabetes (Part 2) – Prevention and the effects of glucose lowering therapies. Diabetes Res Clin Pract. 2020;164:108199. doi: 10.1016/j.diabres.2020.108199. Epub 2020 May 13.
  33. Szczudlik A, Slowik A, Turaj W et al. Transient hyperglycemia in ischemic stroke patients. J Neurol Sci. 2001; 189: 105-111. 34. Gray CS, Hildreth AJ, Sandercock PA, et al. Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia: the UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurol. 2007;6(5):397-406.
  34. Johnston KC, Bruno A, Pauls Q, et al. Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients With Acute Ischemic Stroke: The SHINE Randomized Clinical Trial. JAMA. 2019;322(4):326-335.
  35. Cerecedo-Lopez CD, Cantu-Aldana A, Patel NJ, et al. Insulin in the Management of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. World Neurosurg. 2020;136:e514-e534.
  36. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009 26;360(13):1283-1297.
  37. Masrur S, Cox M, Bhatt DL, et al. Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post-Thrombolysis: Findings From Get With The Guidelines-Stroke. J Am Heart Assoc. 2015;4(10):e002193. doi: 10.1161/JAHA.115.002193.
  38. Tsivgoulis G, Katsanos AH, Mavridis D et al. Association of Baseline Hyperglycemia With Outcomes of Patients With and Without Diabetes With Acute Ischemic Stroke Treated With Intravenous Thrombolysis: A Propensity Score-Matched Analysis From the SITS-ISTR Registry. Diabetes. 2019;68(9):1861-1869.
  39. Reiter M, Teuschl Y, Matz K, et al. Diabetes and thrombolysis for acute stroke: a clear benefit for diabetics. Eur J Neurol. 2014;21(1):5-10.
  40. Rinkel LA, Nguyen TTM, Guglielmi V, et al. High Admission Glucose Is Associated With Poor Outcome After Endovascular Treatment for Ischemic Stroke. Stroke. 2020;51(11):3215-3223.
  41. Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947.