Differential associations between pre-diabetes, diabetes and stroke occurrence among West Africans

J Stroke Cerebrovasc Dis. 2022 Nov;31(11):106805. doi: 10.1016/j.jstrokecerebrovasdis.2022.106805. Epub 2022 Oct 1.


Background: There are limited data from Africa on the burden and associations between pre-diabetes (pre-DM), diabetes mellitus (DM) and stroke occurrence in a region experiencing a profound rise in stroke burden.

Purpose: To characterize the associations between stroke and dysglycemic status among West Africans.

Methods: The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with clinical and radiological evidence of an acute stroke. Controls were age-and-gender matched stroke-free adults. Detailed evaluations for vascular factors were performed. Pre-diabetes was defined as HBA1c of 5.7%-6.4% or Fasting blood glucose (FBG) 5.6-7.0 mmol/L and DM as HBA1c >6.5% or FBG>7.0 mmol/L. We used conditional logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval.

Results: Among 2,935 stroke cases the mean age was 60.0 ± 14.2 years with 55.2% being males. By glycemic status, 931 (31.7%) were euglycemic, 633 (21.6%) had Pre-diabetes and 1371 (46.7%) had DM. Of the age- and sex-matched stroke-free controls 69.2% were euglycemic, 13.3% had pre-DM and 17.5% had DM. Pre-DM [aOR (95% CI): 3.68(2.61-5.21)] and DM [4.29 (3.19-5.74)] were independently associated with stroke. The aOR of Pre-DM for ischemic stroke 3.06 (2.01-4.64)] was lower than 4.82 (3.37-6.89) for DM. However, the aOR of Pre-DM for hemorrhagic stroke 6.81 (95% CI: 3.29 - 14.08)] was higher than 3.36 (1.94-5.86) for DM. Furthermore, the aOR of pre-DM for ischemic stroke subtypes were 9.64 (1.30-71.57) for cardio-embolic stroke, 3.64 (1.80-7.34) for small-vessel occlusive disease and 4.63 (0.80-26.65) for large-vessel disease.

Conclusion: Pre-DM is strongly and independently associated with stroke in Africans. Improving glycemic control through screening, healthy lifestyle and pharmacotherapy at a population level may be strategic in reducing the rising burden of stroke in Africa.

Keywords: Africans; Atherosclerosis; Diabetes mellitus; Dysglycemia; Intracerebral hemorrhage; Pre-diabetes; Stroke.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood Glucose
  • Case-Control Studies
  • Diabetes Mellitus* / diagnosis
  • Diabetes Mellitus* / epidemiology
  • Female
  • Glycated Hemoglobin
  • Humans
  • Ischemic Stroke*
  • Male
  • Middle Aged
  • Prediabetic State* / diagnosis
  • Prediabetic State* / epidemiology
  • Risk Factors
  • Stroke* / diagnosis
  • Stroke* / epidemiology


  • Glycated Hemoglobin A
  • Blood Glucose