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[Diabetes and the central nervous system].
1Klinik für Neurologie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Breslauer Str. 201, 90471, Nürnberg, Deutschland. erbguth@klinikum-nuernberg.de.
Der Nervenarzt
|April 14, 2017
Summary
Diabetes significantly raises stroke risk. While strict glucose control alone isn't superior, multimodal interventions halved stroke risk in diabetic patients over 20 years.
Area of Science:
- Neurology
- Endocrinology
- Cardiovascular Medicine
Background:
- Diabetes mellitus is a significant risk factor for cerebrovascular diseases, increasing stroke risk by 2-4 times.
- Despite this, strict glycemic control alone has not demonstrated superiority over standard treatments for primary and secondary stroke prevention.
- Poststroke hyperglycemia (PSH) affects approximately 50% of stroke patients, correlating with a poorer prognosis.
Purpose of the Study:
- To evaluate the efficacy of multimodal risk interventions in reducing stroke risk in patients with diabetes.
- To investigate the impact of poststroke hyperglycemia (PSH) and its management on stroke outcomes.
- To explore the relationship between diabetes, recurrent hypoglycemia, and the risk of vascular dementia and Alzheimer's disease.
Main Methods:
- Review of studies on stroke prevention in diabetic patients over the past 20 years.
- Analysis of data concerning the prevalence and prognostic significance of poststroke hyperglycemia (PSH).
- Examination of the effects of intravenous (i.v.) insulin therapy and hypoglycemic episodes on stroke outcomes and cognitive function.
Main Results:
- Multimodal risk interventions have reduced stroke risk in diabetic patients by approximately 50% over the last two decades.
- The potentially beneficial effects of strict glycemic control in PSH using i.v. insulin were counteracted by an increased rate of hypoglycemic episodes.
- Recurrent hypoglycemia impairs the brain's ability to perceive and react to low glucose levels, potentially exacerbating neurological damage.
Conclusions:
- Multimodal risk interventions are crucial for effective stroke risk reduction in patients with diabetes.
- Management of PSH requires careful balancing to avoid detrimental hypoglycemic episodes.
- Diabetes poses a dual threat to brain health, increasing risks for stroke, vascular dementia, and Alzheimer's disease, with hypoglycemia further complicating neurological outcomes.