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Abnormal glucose regulation, hypoglycemic treatment during hospitalization and prognosis of acute ischemic stroke

  • Author Footnotes
    1 These authors contributed equally to this work.
    Zhengbao Zhu
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Jingyuan Yang
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China

    Department of Epidemiology, School of Public Health, Guizhou Medical University, Guiyang, China
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  • Chongke Zhong
    Affiliations
    Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
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  • Tan Xu
    Affiliations
    Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
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  • Aili Wang
    Affiliations
    Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
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  • Xiaoqing Bu
    Affiliations
    Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
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  • Yanbo Peng
    Affiliations
    Department of Neurology, Affiliated Hospital of Hebei United University, Hebei, China
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  • Hao Peng
    Affiliations
    Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
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  • Tian Xu
    Affiliations
    Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China

    Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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  • Chung-Shiuan Chen
    Affiliations
    Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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  • Yingxian Sun
    Affiliations
    Department of Cardiology, the First Affiliated Hospital of China Medical University, Liaoning, China
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  • Jing Chen
    Affiliations
    Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

    Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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  • Yonghong Zhang
    Correspondence
    Correspondence to: Y. Zhang, School of Public Health, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou 215123, China.
    Affiliations
    Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
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  • Jiang He
    Correspondence
    Correspondence to: J. He, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, USA.
    Affiliations
    Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

    Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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  • on behalf forthe CATIS Investigation Groups
    Author Footnotes
    2 Investigation Groups in the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) are listed in the Supplementary Appendix.
  • Author Footnotes
    1 These authors contributed equally to this work.
    2 Investigation Groups in the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) are listed in the Supplementary Appendix.
Published:June 13, 2017DOI:https://doi.org/10.1016/j.jns.2017.06.014
Abnormal glucose regulation, hypoglycemic treatment during hospitalization and prognosis of acute ischemic stroke
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      Highlights

      • •
        The first study to show the benefit of hypoglycemic treatment in the 3 months after ischemic stroke.
      • •
        Abnormal glucose regulation increased risks of 3-month poor outcomes after ischemic stroke.
      • •
        Hypoglycemic treatment during hospitalization might improve prognosis in ischemic stroke patients with diabetes.

      Abstract

      Background

      To examine the effect of abnormal glucose regulation on prognosis and whether hypoglycemic treatment during hospitalization improves prognosis in acute ischemic stroke patients.

      Methods

      A total of 3882 acute ischemic stroke patients with an elevated systolic blood pressure between 140 mm Hg and 220 mm Hg were included in the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). The primary outcome was a combination of death and major disability (modified Rankin Scale score ≥ 3) at 3 months after stroke. Secondary outcomes included death, major disability, and vascular events.

      Results

      Compared with normal fasting plasma glucose, odds ratios (95% confidence interval) associated with impaired fasting glucose (IFG) and diabetes mellitus (DM) were 1.25 (0.92–1.68) and 1.38 (1.13–1.67) for composite outcome of death or major disability, respectively, and there was a significant trend for death or major disability (Ptrend = 0.001). A linear association between fasting plasma glucose and the risk of combined outcome of death and major disability was observed among the patients without hypoglycemic treatment during hospitalization (P for linearity = 0.005). We found protective effect of hypoglycemic treatment for risk of death (odds ratio, 0.47; 95% confidence interval, 0.24–0.92) among ischemic stroke patients with DM.

      Conclusions

      Abnormal glucose regulation, especially DM, increased risks of 3-month poor outcomes after an acute ischemic stroke and hypoglycemic treatment during hospitalization might improve prognosis in ischemic stroke patients with DM.

      Keywords

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      Article info

      Publication history

      Published online: June 13, 2017
      Accepted: June 12, 2017
      Received in revised form: May 13, 2017
      Received: March 31, 2017

      Identification

      DOI: https://doi.org/10.1016/j.jns.2017.06.014

      Copyright

      © 2017 Published by Elsevier B.V.

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