Diabetes, fasting glucose levels, and risk of ischemic stroke and vascular events

Bernadette Boden-Albala, Sam Cammack, Ji Chong, Culing Wang, Clinton B Wright, Tatjana Rundek, Mitchell S V Elkind, Myunghee C. Paik, Ralph L Sacco

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE - There is insufficient randomized trial data to support evidence-based recommendations for tight control of fasting blood glucose (FBG) among diabetic subjects in primary stroke prevention. We explored the relationship between FBG among diabetic subjects and risk of ischemic stroke in a multiethnic prospective cohort. RESEARCH DESIGN AND METHODS - Medical and social data and FBG values were collected for 3,298 stroke-free community residents: mean age ± SD was 69 ±10 years; 63% were women, 21% were white, 24% were black, and 53% were Hispanic; and follow-up was 6.5 years. Baseline FBG levels were categorized: 1) elevated FBG: history of diabetes and FBG ≥ 126 mg/dl (7.0 mmol/l); 2) target FBG: history of diabetes and FBG <126 mg/dl (7.0 mmol/l); or 3) no diabetes/reference group. Cox models were used to calculate hazard ratios (HRs) and 95% CI for ischemic stroke and vascular events. RESULTS - In the Northern Manhattan Study, 572 participants reported a history of diabetes and 59% (n = 338) had elevated FBG. Elevated FBG among diabetic subjects was associated with female sex (P < 0.04), Medicaid (P = 0.01), or no insurance (P = 0.03). We detected 190 ischemic strokes and 585 vascular events. Diabetic subjects with elevated FBG (HR 2.7 [95% CI 2.0-3.8]) were at increased risk of stroke, but those with target FBG levels (1.2 [0.7-2.1]) were not, even after adjustment. A similar relationship existed for vascular events: elevated FBG (2.0 [1.6-2.5]) and target FBG (1.3 [0.9-1.8]. CONCLUSIONS - This prospective cohort study provides evidence for the benefits of tighter glucose control for primary stroke prevention.

Original languageEnglish
Pages (from-to)1132-1137
Number of pages6
JournalDiabetes Care
Volume31
Issue number6
DOIs
StatePublished - Jun 1 2008

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Blood Vessels
Blood Glucose
Fasting
Stroke
Glucose
Primary Prevention
Social Adjustment
Medicaid
Insurance
Hispanic Americans
Proportional Hazards Models
Cohort Studies
Research Design
Prospective Studies

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Diabetes, fasting glucose levels, and risk of ischemic stroke and vascular events. / Boden-Albala, Bernadette; Cammack, Sam; Chong, Ji; Wang, Culing; Wright, Clinton B; Rundek, Tatjana; Elkind, Mitchell S V; Paik, Myunghee C.; Sacco, Ralph L.

In: Diabetes Care, Vol. 31, No. 6, 01.06.2008, p. 1132-1137.

Research output: Contribution to journalArticle

Boden-Albala, B, Cammack, S, Chong, J, Wang, C, Wright, CB, Rundek, T, Elkind, MSV, Paik, MC & Sacco, RL 2008, 'Diabetes, fasting glucose levels, and risk of ischemic stroke and vascular events', Diabetes Care, vol. 31, no. 6, pp. 1132-1137. https://doi.org/10.2337/dc07-0797
Boden-Albala B, Cammack S, Chong J, Wang C, Wright CB, Rundek T et al. Diabetes, fasting glucose levels, and risk of ischemic stroke and vascular events. Diabetes Care. 2008 Jun 1;31(6):1132-1137. https://doi.org/10.2337/dc07-0797
Boden-Albala, Bernadette ; Cammack, Sam ; Chong, Ji ; Wang, Culing ; Wright, Clinton B ; Rundek, Tatjana ; Elkind, Mitchell S V ; Paik, Myunghee C. ; Sacco, Ralph L. / Diabetes, fasting glucose levels, and risk of ischemic stroke and vascular events. In: Diabetes Care. 2008 ; Vol. 31, No. 6. pp. 1132-1137.
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abstract = "OBJECTIVE - There is insufficient randomized trial data to support evidence-based recommendations for tight control of fasting blood glucose (FBG) among diabetic subjects in primary stroke prevention. We explored the relationship between FBG among diabetic subjects and risk of ischemic stroke in a multiethnic prospective cohort. RESEARCH DESIGN AND METHODS - Medical and social data and FBG values were collected for 3,298 stroke-free community residents: mean age ± SD was 69 ±10 years; 63{\%} were women, 21{\%} were white, 24{\%} were black, and 53{\%} were Hispanic; and follow-up was 6.5 years. Baseline FBG levels were categorized: 1) elevated FBG: history of diabetes and FBG ≥ 126 mg/dl (7.0 mmol/l); 2) target FBG: history of diabetes and FBG <126 mg/dl (7.0 mmol/l); or 3) no diabetes/reference group. Cox models were used to calculate hazard ratios (HRs) and 95{\%} CI for ischemic stroke and vascular events. RESULTS - In the Northern Manhattan Study, 572 participants reported a history of diabetes and 59{\%} (n = 338) had elevated FBG. Elevated FBG among diabetic subjects was associated with female sex (P < 0.04), Medicaid (P = 0.01), or no insurance (P = 0.03). We detected 190 ischemic strokes and 585 vascular events. Diabetic subjects with elevated FBG (HR 2.7 [95{\%} CI 2.0-3.8]) were at increased risk of stroke, but those with target FBG levels (1.2 [0.7-2.1]) were not, even after adjustment. A similar relationship existed for vascular events: elevated FBG (2.0 [1.6-2.5]) and target FBG (1.3 [0.9-1.8]. CONCLUSIONS - This prospective cohort study provides evidence for the benefits of tighter glucose control for primary stroke prevention.",
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AU - Wright, Clinton B

AU - Rundek, Tatjana

AU - Elkind, Mitchell S V

AU - Paik, Myunghee C.

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