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Stroke Risk Linked to Fasting Blood Glucose in Diabetics

Posted: Wednesday, March 26, 2008

Elevated fasting blood glucose levels among patients with diabetes are strongly linked to an increased adjusted risk for incident ischemic stroke and vascular events, according to the results of a cohort study.

"There is insufficient randomized trial data to support evidence-based recommendations for tight control of fasting blood glucose (FBG) among diabetics in primary stroke prevention," write Bernadette Boden-Albala, MPH, DrPH, from the Columbia University College of Physicians and Surgeons, the Mailman School of Public Health, in New York, NY. "We explored the relationship between FBG among diabetics and risk of ischemic stroke in a multi-ethnic prospective cohort."

The investigators collected medical and social data and FBG levels from 3298 stroke-free community residents. Mean age was 69 ¡À10 years, 63% were women, 21% were white, 24% were black, and 53% were Hispanic. Mean duration of follow-up was 6.5 years.

Participants were categorized into 3 groups based on FBG levels at baseline and a history of diabetes: (1) elevated FBG levels (¡Ý 126 mg/dL [7.0 mmol/L]) and a history of diabetes, (2) target FBG levels (< 126 mg/dL [7.0mmol/L]) with a history of diabetes, or (3) no diabetes/reference group.

Of the 3298 participants in NOMAS, 572 reported a history of diabetes and 338 (59%) had elevated FBG levels. Among those with diabetes, elevated FBG levels were associated with female sex (P = .04), Medicaid (P = .01), or no insurance (P =.03).

During follow-up, there were 190 ischemic strokes and 585 vascular events. Participants with diabetes with elevated FBG levels were at increased risk for stroke (HR, 2.7; 95% CI, 2.0 - 3.8). However, those with target FBG levels were not at increased risk, even after adjustment (HR, 1.2; 95% CI, 0.7 - 2.1). For vascular events, there was a similar relationship between elevated FBG levels and increased risk (HR, 2.0; 95% CI, 1.6 - 2.5), with no increased risk in participants with diabetes who were at target FBG levels (HR, 1.3; 95% CI, 0.9 - 1.8).

"This prospective cohort study provides evidence for the benefits of tighter glucose control for primary stroke prevention," the study authors write.

"A number of issues remain unresolved regarding elevated versus targeted FBG among diabetics," the study authors conclude. "Data from this and other prospective studies provide evidence that targeted FBG levels among diabetes are associated with a reduction of macrovascular risk including ischemic stroke and other vascular events.

Practice Pearls:

This prospective cohort study provides evidence for the benefits of tighter blood glucose control for primary stroke prevention. There was a strong relationship between elevated FBG levels among patients with diabetes and the increased risk for incident ischemic stroke, after adjustment for sociodemographic and vascular risk factors.
Elevated FBG levels among patients with diabetes predicted an increased risk for vascular events, whereas target FBG levels among these patients were not associated with an increased risk.

Source: Diabetes In Control: Diabetes Care. Published online March 13, 2008.