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(Stroke. 1997;28:1153-1157.)
© 1997 American Heart Association, Inc.

Articles

Stroke Recurrence in Diabetics

Does Control of Blood Glucose Reduce Risk?

Milton Alter, MD, PhD; Sue-Min Lai, PhD; Gary Friday, MD; Vineeta Singh, MD; V. Mangesh Kumar, MD; Eugene Sobel, PhD

From the Department of Neurology, Allegheny University Hospitals, Philadelphia, Pa (M.A., G.F., V.S., V.M.K.); the Department of Preventive Medicine, University of Kansas, Kansas City (S.-M. L.); and the Departments of Preventive Medicine and Neurology, University of Southern California, Los Angeles (E.S.).

Background and Purpose Patients with diabetes are at increased risk of stroke. Risk might be reduced if blood glucose level were controlled.

Methods In a population-based study, we enrolled 621 patients within a month of an initial ischemic stroke and followed them regularly twice annually; 198 were diabetic. We monitored blood glucose level in 142 (72%) using glycosylated hemoglobin (HbA_lc). Recurrent stroke frequency was determined by history, examination, and medical records. Cox proportional hazards models were used to examine the relationship between risk of recurrent stroke and HbA_lc level. The models included interaction with time-dependent HbA_lc level and history of diabetes, selected medical comorbidities, age, and sex. HbA_lc level was analyzed as both a continuous and a dichotomous variable (ie, controlled versus uncontrolled); "controlled" was defined with different cut points.

Results All but 17 patients (12%) whose blood glucose was monitored were well controlled (HbA_lc <8%). HbA_lc level was not associated with increased risk of stroke recurrence (hazard ratio [HR], 0.87 per 1% increment in HbA_lc; 95% confidence interval [CI], 0.623 to 1.219), nor was there a trend toward increased risk of recurrent stroke as the cut point defining "controlled" increased: with HbA_lc at <6%, the HR for the uncontrolled group was 0.51 (95% CI, 0.176 to 1.503); at <7%, it was 0.43 (95% CI, 0.089 to 1.923); and at <8%, it was also 0.43 (95% CI, 0.057 to 3.317).

Conclusions Among diabetic patients with an initial stroke, no association between HbA_lc level over time and risk of stroke recurrence was found. However, most patients in this cohort were well controlled, and any adverse effect of poor control could not be adequately tested.

Key Words: diabetes mellitus • glucose • hemoglobin • stroke prevention

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