Correlation between glycemic variability and neurological deterioration in patients with acute ischemic stroke and diabetes mellitus

doi:10.3969/j.issn.1006-7795.2023.01.012

Journal of Capital Medical University ›› 2023, Vol. 44 ›› Issue (1): 78-84.doi: 10.3969/j.issn.1006-7795.2023.01.012

• Basic and Clinical Research on Cerebrovascular Diseases • Previous Articles Next Articles

Correlation between glycemic variability and neurological deterioration in patients with acute ischemic stroke and diabetes mellitus

Li Sen^1,2, Guo Xuewen³, Zhao Xin⁴, Huang Anqi⁴, Lin Jingge¹, Li Xingmao^1,2, Li Xiu^1,2, Du Yifeng⁵, Zhao Yongmei⁶, Bai Jie^1*, Xia Zhangyong^4*

1. Department of Endocrinology, Liaocheng People's Hospital, Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng 252000,Shandong Province,China;
2. School of Clinical Medicine, Weifang Medical University, Weifang 261053,Shandong Province,China;
3. Department of Neurology, Dongchangfu People's Hospital, Liaocheng 252000,Shandong Province,China;
4. Department of Neurology, Liaocheng People's Hospital, Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng 252000,Shandong Province,China;
5. Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021,China;
6. Institute of Cerebrovascular Disease Research, Xuanwu Hospital of Capital Medical University, Beijing 100053,China

Received:2022-11-01 Online:2023-02-21 Published:2023-01-13
Contact: *E-mail: yh2004920@163.com; lcdiabetes@sina.com
Supported by:
Natural Science Foundation of Shandong Province(ZR2017PH054),Shandong Traditional Chinese Medicine Science and Technology Development Project(2019-0887).

Abstract

Abstract: Objective To explore the correlation between glycemic variability and neurological impairment in patients with acute ischemic stroke (AIS) complicated with diabetes mellitus. Methods A total of 125 patients with AIS and diabetes mellitus were selected. The general clinical data at baseline were recorded, and the National Institutes of Health Stroke Scale (NIHSS) was scored at admission and discharge respectively, and the modified Rankin Scale (mRS) score was recorded 1 month after discharge to evaluate neurological changes and disability after stroke. According to whether the NIHSS score worsened or not, the patients were divided into a non-deterioration group and a deterioration group, and the baseline data and glycemic variability parameters were compared between the two groups. Logistic regression was used to analyze the possible factors affecting neurological deterioration, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of blood glucose variability indicators for neurological deterioration. Results There was no statistical difference in baseline clinical data between the two groups, but a statistical differences in blood glucose variability parameters with mean amplitude of glycemic excursions(MAGE) and largest amplitude of glycemic excursions(LAGE) (P<0.05). Binary Logistic regression analysis showed that time in range(TIR) (OR=0.937, P<0.001), MAGE (OR =1.360, P=0.024), and LAGE (OR=1.364, P=0.015) were the risk factors for worsening NIHSS score. Ordinal multivariate Logistic regression analysis showed that MEAN (OR=1.208, P=0.033), MAGE (OR=1.206, P=0.040) and admission fasting blood glucose (OR=1.182, P=0.016) were the risk factors affecting the mRS score. The ROC curve showed that the area under the curve (AUC) of TIR for predicting deterioration was 0.781 (95% CI:0.699－0.862, P<0.001), the sensitivity was 82.6%, the specificity was 60.8%, and the best cut-off value was 41.3%. Conclusion The glycemic variability indicators represented by TIR and others are related factors that may indicate the deterioration of neurological function in patients with AIS and diabetes mellitus.

Key words: glycemic variability, acute ischemic stroke, diabetes, time in range(TIR)

CLC Number:

R743.3

Li Sen, Guo Xuewen, Zhao Xin, Huang Anqi, Lin Jingge, Li Xingmao, Li Xiu, Du Yifeng, Zhao Yongmei, Bai Jie, Xia Zhangyong. Correlation between glycemic variability and neurological deterioration in patients with acute ischemic stroke and diabetes mellitus[J]. Journal of Capital Medical University, 2023, 44(1): 78-84.

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Correlation between glycemic variability and neurological deterioration in patients with acute ischemic stroke and diabetes mellitus

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