Background: Glycemic gap, as a novel index of acute glycemic excursion, is associated with poor prognosis of different diseases. This study aimed to explore the association of the glycemic gap with long-term stroke recurrence in patients with ischemic stroke.
Methods: This study included patients with ischemic stroke from the Nanjing Stroke Registry Program. The glycemic gap was calculated by subtracting the estimated average blood glucose from the blood glucose at admission. Multivariable Cox proportional hazards regression analysis was performed to explore the association between the glycemic gap and the risk of stroke recurrence. The Bayesian hierarchical logistic regression model was used to estimate the effects of the glycemic gap on stroke recurrence stratified by diabetes mellitus and atrial fibrillation.
Results: Among 2734 enrolled patients, 381 (13.9%) patients experienced stroke recurrence during a median follow-up of 3.02 years. In multivariate analysis, glycemic gap (high group vs. median group) was associated with significantly increased risk for stroke recurrence (adjusted hazard ratio, 1.488; 95% confidence interval, 1.140-1.942; p = .003) and had varying effects on stroke recurrence depending on atrial fibrillation. The restricted cubic spline curve showed a U-shaped relationship between the glycemic gap and stroke recurrence (p = .046 for nonlinearity).
Conclusion: Our study found that the glycemic gap was significantly associated with stroke recurrence in patients with ischemic stroke. The glycemic gap was consistently associated with stroke recurrence across subgroups and had varying effects depending on atrial fibrillation.
背景:血糖间隙作为一种新的急性血糖波动指标, 与不同疾病的不良预后有关。本研究旨在探讨缺血性脑卒中患者血糖间隙与长期卒中复发的关系。 方法:本研究纳入了来自南京卒中登记项目的缺血性卒中患者。血糖间隙通过从入院时的血糖中减去估计的平均血糖来计算。采用多变量Cox比例风险回归分析, 探讨血糖间隙与卒中复发风险之间的关系。采用贝叶斯分层logistic回归模型估计血糖间隙对糖尿病和房颤分层卒中复发的影响。 结果:在2734例入组患者中, 381例(13.9%)患者在3.02年的中位随访期间出现卒中复发。在多变量分析中, 血糖间隙(高组vs中值组)与卒中复发风险显著增加相关(校正危险比, 1.488;95%置信区间为1.140 ~ 1.942;P = 0.003), 心房颤动对卒中复发有不同的影响。限制三次样条曲线显示血糖间隙与卒中复发呈U型关系(p =0.0046表示非线性)。 结论:我们的研究发现, 血糖间隙与缺血性卒中患者的卒中复发有显著关系。在各个亚组中, 血糖间隙始终与卒中复发相关, 并且根据房颤的不同有不同的影响。.
Keywords: A1C-derived average glucose; A1C衍生的平均葡萄糖; glycemic gap; ischemic stroke; recurrence; 复发; 缺血性卒中; 血糖间隙.
© 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.