Diabetes, hyperglycemia and the management of cerebrovascular disease

Curr Opin Neurol. 2011 Feb;24(1):81-8. doi: 10.1097/WCO.0b013e3283418fed.


Purpose of review: Hyperglycemia is frequent in patients with cerebrovascular disease. This review article aims to summarize the recent evidence from observational studies that examined the adverse cerebrovascular effects of dysglycemic states as well as interventional studies assessing intensive management strategies for hyperglycemia.

Recent findings: In recent years, diabetes, prediabetic states and insulin resistance and their association with cerebrovascular disease were an important focus of research. The cerebrovascular consequences of these metabolic abnormalities were found to extend beyond ischemic stroke to covert brain infarcts, other structural brain changes and to cognitive impairment with and without dementia. Interventional studies did not reveal that more intensive management of chronic hyperglycemia and of hyperglycemia in the setting of acute stroke improves outcome. There is clear evidence, however, that the overall management of multiple risk factors and behavior modification in patients with dysglycemia may reduce the burden of cerebrovascular disease.

Summary: Observational studies reveal the growing burden and adverse cerebrovascular effects of dysglycemic states. Currently available interventional studies assessing more intensive strategies for the management of hyperglycemia did not prove, however, to be effective. We discuss the current evidence, pathophysiological considerations and management implications.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Brain / pathology
  • Cerebrovascular Disorders / pathology
  • Cerebrovascular Disorders / therapy*
  • Clinical Trials as Topic
  • Cognition / physiology
  • Cognition Disorders / etiology
  • Cognition Disorders / physiopathology
  • Cognition Disorders / prevention & control
  • Cost of Illness
  • Diabetes Mellitus / pathology
  • Diabetes Mellitus / therapy*
  • Diabetic Angiopathies / pathology
  • Diabetic Angiopathies / therapy*
  • Humans
  • Hyperglycemia / pathology
  • Hyperglycemia / therapy*
  • Insulin Resistance / physiology
  • Metabolic Syndrome / physiopathology
  • Prediabetic State / pathology
  • Prediabetic State / therapy
  • Stroke / etiology