The persistent challenge of ischemic stroke burden from high fasting plasma glucose: a global perspective

Does your competent? doctor have this as a testing protocol to prevent your next stroke? NO? So, you DON'T have a functioning stroke doctor, do you? Your doctor should not be surprised by research you point out to them. If they are; YOU NEED TO GET THEM FIRED!

If I can facilitate removal of dead wood in stroke, one of my goals is accomplished.  My goal is to get everyone in stroke working directly towards 100% recovery protocols; a very doable goal, naysayers can just shut the fuck up and let better persons solve it. 

 The persistent challenge of ischemic stroke burden from high fasting plasma glucose: a global perspective

Zhenhai Sun 1, Menghe Zhang 2, Yaoyao Zuo 2, Wenwen Li 1, Shudi Li 1, Yunxiao Zhang 1 and Shouqiang Chen 2*

1 Second School of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China, 2 Department of Cardiology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China

Edited by:

Santi Martini , Airlangga University, Indonesia

Reviewed by:

Harapan Harapan, Syiah Kuala University, Indonesia

Chenan Liu, Capital Medical University, China

Zhouyu Guan, Shanghai Jiao Tong University, China

*Correspondence:

Shouqiang Chen

csq23800@163.com

Received: 03 September 2024

Accepted: 16 April 2025

Published: 06 May 2025

Citation:

Sun Z, Zhang M, Zuo Y, Li W, Li S, Zhang Y and Chen S (2025) The persistent challenge of ischemic stroke burden from high fasting plasma glucose: a global perspective. Front. Endocrinol. 16:1490428. doi: 10.3389/fendo.2025.1490428

BackgroundIschemic stroke is a leading cause of disability and mortality worldwide, with high fasting plasma glucose (HFPG) recognized as a critical modifiable risk factor. This study aimed to evaluate the global disease burden of ischemic stroke attributable to HFPG and predict trends over the next 15 years.

MethodsWe utilized the comparative risk assessment method from the Global Burden of Disease (GBD) 2021 study to quantify disease burden in terms of deaths, Disability-Adjusted Life Years (DALYs), and their age-standardized rates. The estimated annual percent changes (EAPCs) were calculated to evaluate temporal trends. Additionally, our analysis included health inequality analysis, decomposition analysis, and predictive analysis employing the Bayesian Age-Period-Cohort model (BAPC).

ResultsIn 2021, the global deaths and DALYs attributable to ischemic stroke due to HFPG were 659,378 (95% UI: 507,502 to 823,945) and 12,371,434 (95% UI: 9,587,506 to 15,382,662), respectively. Notably, both figures have doubled since 1990. Over the past 30 years, both the age-standardized mortality rate (ASMR) and the age-standardized DALY rate (ASDR) have experienced a significant decline, with EAPC of -0.96 (95% CI: -1.05 to -0.86) and -0.72 (95% CI: -0.81 to -0.62), respectively. High-middle and middle Socio-Demographic Index (SDI) regions represented the primary locations of disease burden, while this burden is gradually shifting towards low SDI regions. Furthermore, the burden was more significant in men than in women and was more pronounced in middle-aged and elderly populations compared to younger individuals. Population growth and aging were the principal factors contributing to the increasing disease burden. Additionally, projections indicate that the disease burden will exhibit a downward trend over the next 15 years.

ConclusionFor over 30 years, while ASMR and ASDR have shown a decline, the deaths and DALYs attributable to ischemic stroke resulting from HFPG continue to rise globally. This trend underscores the persistent public health challenge posed by ischemic stroke associated with HFPG. Future targeted medical strategies should prioritize populations beyond those with High SDI, especially concentrating on middle-aged and elderly individuals and male patients.

Keywords: global burden, high fasting plasma glucose, ischemic stroke, disability-adjusted life years, mortality

1 INTRODUCTION

Stroke encompasses a range of acute cerebrovascular diseases resulting from either hemorrhage or ischemia. These conditions are characterized by high rates of morbidity, mortality, disability, and recurrence, affecting approximately 13.7 million people worldwide each year and posing a significant threat to global public health (1). Among the various subtypes of stroke, ischemic stroke is particularly significant, accounting for 80% of all stroke cases (2). By 2019, ischemic stroke accounted for 3.29 million fatalities and resulted in 63.48 million Disability-Adjusted Life Years (DALYs) (3). Catastrophic health expenditures during this period totaled an alarming US$964.51 billion. This significant financial burden on healthcare systems represented approximately 0.78% of the world’s GDP (4). Despite advancements in addressing the challenges associated with ischemic stroke, it remains a critical public health issue, imposing substantial financial and healthcare burdens.

Previous studies have demonstrated that excessive blood glucose levels can directly lead to significant health issues such as diabetes or indirectly increase susceptibility to related diseases, including ischemic heart disease and ischemic stroke (5, 6). Research has confirmed that hyperglycemia can independently enlarge the lesion area following ischemic stroke and elevate associated mortality and disability rates (7). Additionally, another study indicated that hyperglycemia may diminish the clinical efficacy of thrombolysis or thrombectomy, which are important treatments for patients with ischemic stroke. This reduction in efficacy may lead to increased patient mortality and worsening of neurological impairment, ultimately resulting in a poorer prognosis (8). However, because hyperglycemia is primarily characterized by elevated blood sugar levels in the early stages and rarely presents obvious clinical symptoms, there is a lack of understanding regarding its potential health impacts. Notably, the Global Burden of Disease (GBD) framework defines high fasting plasma glucose (HFPG) as fasting blood glucose levels exceeding 4.8 - 5.4 mmol/L (theoretical minimum risk exposure level, TMREL) (9). This standard is grounded in continuous risk evidence and encompasses the subclinical population that does not meet the diabetes threshold but experiences a long-term cumulative increase in stroke risk. This definition is instrumental in shaping public health policies and offers a scientific foundation for early intervention and prevention strategies.

Previous studies have primarily concentrated on the impact of HFPG on the overall disease burden or the burden of stroke attributable to various comprehensive risk factors (10, 11). However, few studies have quantified the specific burden of HFPG on ischemic stroke in isolation. While a regional study has reported time trends of HFPG-related ischemic stroke burden in China, a systematic global assessment remains lacking, particularly concerning long-term trends, gender and age heterogeneity, and future predictions (12). We hypothesize that HFPG plays a significant but underrecognized role in the burden of ischemic stroke, particularly in older and male populations. Therefore, to systematically evaluate the impact of HFPG on ischemic stroke burden, we analyzed the global age- and sex-specific disease burden using data from the GBD 2021 study. The analysis also included trends in spatial distribution and temporal distribution. Additionally, we projected the global disease burden over the next 15 years. The findings of this study may provide valuable evidence for policymakers to assess and formulate short- and long-term strategies for managing ischemic stroke linked to HFPG.

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