ROLE OF GLYCOSYL ATED HEMOGLOBIN TESTING IN PATIENTS WITH CEREBRAL STROKE
Keywords:сerebral stroke, diabetes mellitus, glycosylated hemoglobin, glycemia, prognosis
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.
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