ROLE OF GLYCOSYL ATED HEMOGLOBIN TESTING IN PATIENTS WITH CEREBRAL STROKE

Authors

  • Flomin Y. V. Medical center «Universal clinic «Oberig», Kyiv, Ukraine
  • Gurianov V. G. Bogomolets National Medical University, Ministry of Health of Ukraine, Kyiv, Ukraine
  • Sokolova L. K. V. Komisarenko State Institute of Endocrinology and Metabolism National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine;
  • Taran L. F. Medical center «Universal clinic «Oberig», Kyiv, Ukraine
  • Sokolova L. I. Bogomolets National Medical University, Ministry of Health of Ukraine, Kyiv, Ukraine

DOI:

https://doi.org/10.21856/j-PEP.2021.1.09

Keywords:

сerebral stroke, diabetes mellitus, glycosylated hemoglobin, glycemia, prognosis

Abstract

Background. Cerebral stroke (CS) and diabetes mellitus (DM) are common noncommunicable diseases with multifaceted interactions. The glycosylated hemoglobin (HbA1c) testing is a convenient and reliable method for detecting DM and evaluating its control, but the role of HbA1c in CS is not well established. The aim of the study was to explore feasibility and significance of HbA1c testing among CS in-patients in clinical practice by studying the relationship between the HbA1c level and demographic data, CS severity, vascular risk factors, CS period, its subtype and outcome. 74 Проблеми ендокринної патології №1, 2021 Клінічна ендокринологія Material and methods. Data of 524 inpatients (43.4% women) with a verified CS, who were admitted 2010 through 2018 in various CS periods (from hyperacute to chronic) were analyzed. All patients had an HbA1c level determined upon admission, and underwent all necessary ancillary investigations according to current guidelines in addition to assessment with relevant scales, such as the National Institutes of Health Stroke Scale (NIHSS), Bartel index and modified Rankin scale (mRS). Categorical variables are shown as numbers and percentages. Variables with abnormal distribution were expressed as median (Me) and the interquartile range (IQR). Statistical analysis of the data was carried out in MedCalc v. 19.1 package. Results. Participants’ age ranged from 30.7 years to 95.7 years (Me 67.3, IQR 59.3–75.5). In 81 (15.4%) the diagnosis of hemorrhagic CS was made, whereas 443 (84.6%) subjects had ischemic CS. The baseline NIHSS score ranged from 0 to 39 points (Me 11, IQR 6–18). In our sample, high frequency of vascular risk factors was documented: 86.5% suffered from arterial hypertension, 41.1% had dyslipidemia, 24.7% were current smokers, and 27.1% had recurrent CS. Among the participants, 33.4% had a history of DM, while in 4.2% type 2 diabetes was detected de novo. Apart from that, prediabetes was diagnosed in 34.4% of the subjects. Among patients with a history of DM, 21% had initial HbA1c 7.0% to 8.0%, and 28% had HbA1c over 8.0%. Baseline HbA1c level did not correlate with demographic characteristics, vascular risk factors (except for DM and obesity), baseline stroke severity, and activities of daily living (Barthel Index score) at discharge. However, a higher HbA1c level was significantly (p < 0.05) associated with ischemic CS, its atherosclerotic subtype, and the worse global CS outcome (final mRS score). Conclusions. HbA1c testing in inpatients with CS in clinical practice appears feasible and justified, since it allows detecting DM or prediabetes as well as prescribing the necessary treatment prior to discharge. More frequent HbA1c testing in patients with DM can contribute to both more effective CS prevention and an improved prognosis in the case of acute CS.

References

Brainin M, Feigin VL, Norrving B, et al. Lancet Neurol 2020; 19(6): 487-488. https://doi.org/10.1016/S1474-4422(20)30141-1.

IDF Diabetes Atlas, 9th ed. Brussels: International Diabetes Federation, 2019, available at: https://www.diabetesatlas.org/en/

Phipps MS, Jastreboff AM, Furie K, Kernan WN. Curr Diab Rep 2012; 12(3): 314-323. https://doi.org/10.1007/s11892-012-0271-x.

Lau LH, Lew J, Borschmann K, et al. J Diabetes Invest 2019; 10(3): 780-792. https://doi.org/10.1111/jdi.12932.

Hill MD. Handb Clin Neurol 2014; 126: 167-174. https://doi.org/10.1016/B978-0-444-53480-4.00012-6.

Lei C, Wu B, Liu M, Chen Y. J Clin Neurosci 2015; 22(3): 498-503. https://doi.org/10.1016/j.jocn.2014.08.030.

Tuttolomondo A, Pinto A, Salemi G, et al. Nutr Metab Cardiovasc Dis 2008; 18(2): 152-157. https://doi.org/doi: 10.1016/j.numecd.2007.02.003.

Zhao L, Wang L, Lu M, et al. Medicine (Baltimore) 2019; 98(31): e16723. https://doi.org/10.1097/MD.0000000000016723.

Wang H, Cheng Y, Chen S, et al. J Stroke Cerebrovasc Dis 2019; 28(2): 470-476. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.10.026.

d’Emden MC, Shaw JE, Colman PG, et al. Med J Aust 2012; 197(4): 220-221. https://doi.org/10.5694/mja12.10988.

Sequeira IR, Poppitt SD. Insights Nutr Metabol 2017; 1(1): 11-20.

Huisa BN, Roy G, Kawano J, Schrader R. J Stroke Cerebrovasc Dis 2013; 22(8): e564-e567. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.06.023.

American Diabetes Association. Diabetes Care 2020; 43(1): S14-S31. https://doi.org/10.2337/dc20-S002.

World Health Organization. Obesity and overweight, Geneva, 2020, available at: https://www.who.int/newsroom/fact-sheets/detail/obesity-and-overweight.

Halawani FMA, Alahmari SZ, Asiri AD, et al. Arch Pharma Pract 2019;10(4): 67-70, available at: https://archivepp.com/storage/models/article/3m8LcQ1PlYrNoaphvNC8ZNGzdft178hh5fVw6vo1jf3BbiSBFmqsqfFCwb7q/diagnosis-and-management-of-dyslipidemia.pdf).

Bernhardt J, Hayward KS, Kwakkel G, et al. Int J Stroke 2017; 12(5): 444-450. https://doi.org/10.1177/1747493017711816.

O’Donnell MJ, Chin SL, Rangarajan S, et al. Lancet 2016; 388. https://doi.org/10.1016/S0140-6736(16)30506-2.

Selvin E, Coresh J, Shahar E, et al. Lancet Neurol 2005; 4(12): 821-826. https://doi.org/10.1016/S1474-4422(05)70227-1.

Luitse MJ, Velthuis BK, Kappelle LJ, et al. Int J Stroke 2017; 12(2): 180-186. https://doi.org/10.1177/1747493016676619.

Tamura Y, Araki A. Geriatr Gerontol Int 2015; 15(1): 34-42. https://doi.org/10.1111/ggi.1266

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Published

2021-03-03

How to Cite

Фломін, Ю. В., Гур’янов, В. Г., Соколова, Л. К., Таран, Л. Ф., & Соколова, Л. І. (2021). ROLE OF GLYCOSYL ATED HEMOGLOBIN TESTING IN PATIENTS WITH CEREBRAL STROKE. Problems of Endocrine Pathology, 75(1), 66-74. https://doi.org/10.21856/j-PEP.2021.1.09

Issue

Section

CLINICAL ENDOCRINOLOGY

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