Association of glycemic gap with stroke recurrence in patients with ischemic stroke
Kang Yuan1, Mengdi Xie2, Huajuan Hou1
1Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Insights
The glycemic gap, a measure of blood sugar fluctuations, is linked to a higher risk of stroke recurrence in ischemic stroke patients. This finding highlights its importance in predicting long-term outcomes.
Area of Science:
- Neurology
- Endocrinology
- Cardiology
Background:
- The glycemic gap, an indicator of acute glucose variability, is linked to adverse outcomes in various conditions.
- Understanding its role in ischemic stroke is crucial for prognosis.
Purpose of the Study:
- To investigate the association between the glycemic gap and long-term stroke recurrence in patients with ischemic stroke.
- To explore how factors like diabetes and atrial fibrillation modify this association.
Main Methods:
- Utilized data from the Nanjing Stroke Registry Program, including 2734 ischemic stroke patients.
- Calculated glycemic gap using admission blood glucose and estimated average blood glucose.
- Employed multivariable Cox regression and Bayesian hierarchical logistic regression for analysis.
Main Results:
- Stroke recurrence occurred in 13.9% of patients over a median follow-up of 3.02 years.
- A higher glycemic gap was significantly associated with an increased risk of stroke recurrence (aHR=1.488).
- A U-shaped relationship was observed between glycemic gap and stroke recurrence, with varying effects influenced by atrial fibrillation.
Conclusions:
- The glycemic gap is a significant predictor of long-term stroke recurrence in ischemic stroke patients.
- The association remains consistent across subgroups, but is modulated by the presence of atrial fibrillation.
Background:
Glycemic gap, as a novel index of acute glycemic excursion, is associated with poor prognosis of different diseases. This study aimed to explore the association of the glycemic gap with long-term stroke recurrence in patients with ischemic stroke.
Methods:
This study included patients with ischemic stroke from the Nanjing Stroke Registry Program. The glycemic gap was calculated by subtracting the estimated average blood glucose from the blood glucose at admission. Multivariable Cox proportional hazards regression analysis was performed to explore the association between the glycemic gap and the risk of stroke recurrence. The Bayesian hierarchical logistic regression model was used to estimate the effects of the glycemic gap on stroke recurrence stratified by diabetes mellitus and atrial fibrillation.
Results:
Among 2734 enrolled patients, 381 (13.9%) patients experienced stroke recurrence during a median follow-up of 3.02 years. In multivariate analysis, glycemic gap (high group vs. median group) was associated with significantly increased risk for stroke recurrence (adjusted hazard ratio, 1.488; 95% confidence interval, 1.140-1.942; p = .003) and had varying effects on stroke recurrence depending on atrial fibrillation. The restricted cubic spline curve showed a U-shaped relationship between the glycemic gap and stroke recurrence (p = .046 for nonlinearity).
Conclusion:
Our study found that the glycemic gap was significantly associated with stroke recurrence in patients with ischemic stroke. The glycemic gap was consistently associated with stroke recurrence across subgroups and had varying effects depending on atrial fibrillation.
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