This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 38/9/2526    most recent STROKEAHA.107.482216v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kunte, H. Articles by Dirnagl, U. Search for Related Content PubMed PubMed Citation Articles by Kunte, H. Articles by Dirnagl, U. Pubmed/NCBI databases Medline Plus Health Information Diabetes Stroke Related Collections Type 2 diabetes Acute Cerebral Infarction Neuroprotectors Related Article

(Stroke. 2007;38:2526.)
© 2007 American Heart Association, Inc.

Original Contributions

Sulfonylureas Improve Outcome in Patients With Type 2 Diabetes and Acute Ischemic Stroke

Hagen Kunte, MD; Sein Schmidt, MD; Michael Eliasziw, PhD; Gregory J. del Zoppo, MD; J. Marc Simard, MD, PhD; Florian Masuhr, MD; Markus Weih, MD Ulrich Dirnagl, MD

From the Department of Neurology (H.K., S.S., F.M., U.D.), Center for Stroke Research, Humboldt University, Berlin, Germany; the Departments of Community Health Sciences and Clinical Neurosciences (M.E.), University of Calgary, Calgary, Alberta, Canada; the Department of Molecular and Experimental Medicine (G.J.d.Z.), The Scripps Research Institute, La Jolla, Calif; the Departments of Neurosurgery, Pathology and Physiology (J.M.S.), School of Medicine, University of Maryland at Baltimore, Baltimore, Md; and the Department of Psychiatry (M.W.), Friedrich-Alexander-University, Erlangen-Nuernberg, Erlangen, Germany.

Correspondence to J. Marc Simard, Department of Neurosurgery, 22 S Greene Street, Suite 12SD, Baltimore, MD 21201-1595. E-mail msimard{at}smail.umaryland.edu

Background and Purpose— The sulfonylurea receptor 1-regulated NC_Ca-ATP channel is upregulated in rodent models of stroke with block of the channel by the sulfonylurea, glibenclamide (glyburide), significantly reducing mortality, cerebral edema, and infarct volume. We hypothesized that patients with type 2 diabetes mellitus taking sulfonylurea agents both at the time of stroke and during hospitalization would have superior outcomes.

Methods— We reviewed medical records of patients with diabetes mellitus hospitalized within 24 hours of onset of acute ischemic stroke in the Neurology Clinic, Charité Hospital, Berlin, Germany, during 1994 to 2000. After exclusions, the cohort comprised 33 patients taking a sulfonylurea at admission through discharge (treatment group) and 28 patients not on a sulfonylurea (control group). The primary outcome was a decrease in National Institutes of Health Stroke Scale of 4 points or more from admission to discharge or a discharge National Institutes of Health Stroke Scale score of 0. The secondary outcome was a discharge modified Rankin Scale score 2.

Results— No significant differences, other than stroke subtype, were observed among baseline variables between control and treatment groups. The primary outcome was reached by 36.4% of patients in the treatment group and 7.1% in the control group (P=0.007). The secondary outcome was reached by 81.8% versus 57.1% (P=0.035). Subgroup analyses showed that improvements occurred only in patients with nonlacunar strokes and were independent of gender, previous transient ischemic attack, and blood glucose levels.

Conclusion— Sulfonylureas may be beneficial for patients with diabetes mellitus with acute ischemic stroke. Further investigation of similar cohorts and a prospective randomized trial are recommended to confirm the present observations.

Key Words: cerebral ischemia • diabetes mellitus • glibenclamide • stroke • sulfonylurea

Related Article:

Potential Impact of Sulfonylureas in the Outcome of Type 2 Diabetic Patients With Ischemic Stroke

Adrià Arboix
Stroke 2007 38: 2413-2414. [Full Text] [PDF]

This article has been cited by other articles:

				M. Kamalesh, J. Shen, and G. J. Eckert Long Term Postischemic Stroke Mortality in Diabetes: A Veteran Cohort Analysis Stroke, October 1, 2008; 39(10): 2727 - 2731. [Abstract] [Full Text] [PDF]