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Clinical Summary

Do rising glycated haemoglobin levels influence the risk for stroke?

Takeaway

  • Increasing levels of glycated haemoglobin (HbA1c) are strongly associated with increased risk for first-ever stroke among individuals with a diabetes diagnosis and increased risk for first-ever ischaemic stroke among patients without a diabetes diagnosis.

Why this matters

  • The American Diabetes Association’s diabetes mellitus management guidelines recommend a base target of <7.0% HbA1c level.
  • Nearly half of all patients presenting with acute stroke have previously reported unknown abnormalities of glucose tolerance, with 20% to 40% of patients presenting with hyperglycaemia at hospital admission.

Study design

  • Systematic review and meta-analysis of 29 articles including 532,779 participants with and without type 1 or type 2 diabetes mellitus.
  • Funding: Operational Infrastructure Support Grant.

Key results

  • A HbA1c level ≥6.5% was associated with a significantly increased risk for first-ever stroke in individuals with diabetes vs those without diabetes (average HR, 2.15; 95% CI, 1.76-2.63).
  • For every 1% increase in HbA1c level, the average HR for first-ever stroke was 1.12 (95% CI, 0.91-1.39) in individuals without diabetes and 1.17 (95% CI, 1.09-1.25) in individuals with diabetes.
  • For every 1% increase in HbA1c levels, the average HR for first-ever ischaemic stroke was 1.49 (95% CI, 1.32-1.69) in individuals without diabetes and 1.24 (95% CI, 1.11-1.39) in individuals with diabetes.

Limitations

  • Risk for bias.

References


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