The Association of Glycemic Gap with Cognitive Function After Ischemic Stroke or Transient Ischemic Attack

 Known of the problem since May 2018; DID NOTHING TO SOLVE IT! YOU'RE FIRED!

• glycemic control (5 posts to May 2018)

The Association of Glycemic Gap with Cognitive Function After Ischemic Stroke or Transient Ischemic Attack

Authors Min Y, Xu Q, Wang Y, Li Z

Received 29 January 2025

Accepted for publication 2 July 2025

Published 19 July 2025 Volume 2025:21 Pages 1425—1433

DOI https://doi.org/10.2147/NDT.S519935

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Jun Chen

Download Article [PDF] 

Yan Min,¹ Qin Xu,^1,2 Yongjun Wang,^{1– 3} Zixiao Li<sup>1,2,4

1</sup>Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, People’s Republic of China; ²China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China; ³Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People’s Republic of China; ⁴Chinese Institute for Brain Research, Beijing, People’s Republic of China

Correspondence: Yongjun Wang, Beijing TianTan Hospital, Capital Medical University, Beijing, People’s Republic of China, Tel +86 010 59978351, Email yongjunwang@ncrcnd.org.cn Zixiao Li, Beijing TianTan Hospital, Capital Medical University, Beijing, People’s Republic of China, Tel +86 010 59978351, Email lizixiao2008@hotmail.com

Background: Glycemic gap (GG), as a measure of an acute derangement in glucose level in response to an active disease state, has been found to be associated with adverse outcomes in many diseases. This study aimed to determine the relationship of GG with cognitive function after ischemic stroke or transient ischemic attack (TIA).
Methods: Patients included were enrolled from a subgroup of China National Stroke Registry-III (CNSR-III). Cognitive function was assessed by the Beijing edition of the Montreal cognitive assessment (MoCA) scale. Post-stroke cognitive impairment (PSCI) was diagnosed as a MoCA score≤ 22. Post-stroke cognitive decline (PSCD) was defined as a decrease of > 2 points on the MoCA score between the 3-month and 1-year assessments. GG was calculated using admission blood glucose minus hemoglobin A1c-derived average blood glucose. Multivariable logistic regression analysis was used to evaluate the correlation between GG and cognitive function.
Results: We enrolled 767 patients with a median age of 60 years old, including 247 (32.2%) patients with PSCI in 3 months, 228 (29.73%) with PSCI in 1 year, and 166 (21.64%) patients with PSCD. The highest GG levels were related to PSCI in 3 months after adjusted for multiple potential confounders (adjusted odd ratio (OR): 2.021, 95% CI: 1.055– 3.869, P=0.0338), but not in patients with PSCI in 1 year or PSCD. No significant interactions for the impact on PSCI were observed in subgroups (P interaction > 0.05 for all).
Conclusion: Our findings show that GG is associated with acute post-stroke cognitive impairment, but not with the long-term cognitive impairment or cognitive decline.

Safety and Efficacy of Tight Versus Loose Glycemic Control in Acute Stroke Patients: A Meta-Analysis of Randomized Controlled Trials

Will your competent? doctor and hospital ensure further research occurs? Or WILL THEY INCOMPETENTLY DO NOTHING?

Weren't they already aware of this  and knew further research was needed?

• glycaemic control (2 posts to May 2023)

Do you prefer your  doctor and hospital incompetence NOT KNOWING? OR NOT DOING?

 

Safety and Efficacy of Tight Versus Loose Glycemic Control in Acute Stroke Patients: A Meta-Analysis of Randomized Controlled Trials

Shuangzhe Wu, Yuke Mao, […], and Donghua Mi https://orcid.org/0000-0001-8845-8769 midonghua131@163.com+5View all authors and affiliations

Accepted Manuscripts

https://doi.org/10.1177/17474930241241994

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Abstract

Background:

Hyperglycemia is associated with worse stroke outcomes but it is uncertain whether tight glycaemic control during the acute stroke period is associated with a better outcome. We conducted a meta-analysis to compare the effect of tight glycemic control versus loose glycemic control in the acute phase of stroke patients.

Methods:

A literature search was performed to identify randomized controlled trials (RCTs) comparing the safety and efficacy of tight glycemic control with a relatively loose control of blood glucose of acute stroke (ischemic or hemorrhagic) patients within 24 hours after stroke onset. We required that the blood glucose level of the patients should not be lower than 6.11mmol/L at the time of enrollment, and for the intensive blood glucose control range, we defined the blood glucose level as lower than that of the control group.Tight glycaemic control was defined as blood glucose ≥ 6.11 mmol/L. The primary efficacy outcome measure was deaths from any cause at 90 days. Secondary efficacy outcomes comprised the number of participants with modified Rankin score (mRS), We define mRS scores 0-2 as favorable scores, recurrent stroke, and the National Institute of Health stroke scale (NIHSS) or the European Stroke Scale (ESS) scores. We defined the number of participants with hypoglycemia as our primary safety outcome. Subgroup analysis was performed according to age, the variety of interventions, maintained glucose level, and status of hypoglycemia on NIHSS scores or ESS scores.

Results:

Fifteen RCTs with 2957 participants meeting the including criteria were identified and included in this meta-analysis, although not all included data on every outcome measure. Data on the primary efficacy endpoint, mortality at 90 days, was available in 11 RCTs a total of 2575 participants. There was no significant difference between the intervention and control groups (OR: 1.00; 95%CI: 0.81 to 1.23; P=0.99). For secondary endpoints, there was no difference between intervention and control groups for a mRS < from 0-2 (OR: 0.96; 95%CI: 0.80 to 1.15; P=0.69; data from 9 RCTs available), or recurrent stroke (OR: 1.34; 95%CI: 0.92 to 1.96; P=0.13; data from 3 RCTs available). For NIHSS scores or ESS scores, there was a small difference in favor of intensive controls (SMD: -0.29; 95%CI: -0.54 to -0.04; P=0.02) There was a marked increase in hypoglycemia with tight control: (OR of 9.46 (95%CI: 4.59 to 19.50; P<0.00001; data from 9 RCTs available)

Conclusions:

There was no difference between tight and loose glycemic control on mortality, independence, or recurrent stroke outcome in acute stroke, but an increase in hypoglycaemia. There was a small effect improvement on neurological scales but the relevance of this needs confirming in future adequately powered studies.

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Blood Sugar May Be Key to Brain Power After a Stroke

Will this prompt your stroke hospital to create protocols for testing this and then followup protocols to prevent cognitive decline from happening? Or is your hospital incompetent in not even knowing about this?

Do you prefer your  doctor and hospital incompetence NOT KNOWING? OR NOT DOING?

 

Blood Sugar May Be Key to Brain Power After a Stroke

By Cara Murez HealthDay Reporter

(HealthDay)

FRIDAY, May 19, 2023 (HealthDay News) -- Having higher blood sugar can lead to quicker loss of brain power after a stroke, a new study suggests.

High blood pressure and cholesterol were not associated with a similar mental loss, even in those at higher genetic risk for dementia.

“Having a stroke increases a person’s risk of dementia up to 50-fold, but we lack a comprehensive treatment approach that could reduce this risk, other than preventing a second stroke,” said study co-author Dr. Deborah Levine, a professor of medicine and neurology at the University of Michigan Medical School.

“These findings suggest that higher cumulative blood sugar levels after stroke contribute to faster cognitive decline, and hyperglycemia [excess blood sugar] after stroke, regardless of diabetes status, could be a potential treatment target to protect post-stroke cognition,” Levine said in a Michigan Health news release.

Researchers used data from the STROKE COG study, which pooled data from four long-term U.S. studies. The new study looked at nearly 1,000 people whose measurements of brain function and blood tests were taken for years before and after they had a stroke.

Stroke survivors with high blood sugar had a much quicker loss of general thinking ability. However, high blood sugar did not affect executive function (complex decision-making ability) or memory, according to the study.

The team adjusted the data for differences in factors such as age, income, education, and use of medications to treat high blood pressure, cholesterol and blood sugar. Post-stroke blood sugar measurements were taken an average of two years after their first stroke. About 20% of the study participants were taking diabetes medication before their stroke.

Further research is needed to test whether tight blood sugar control in stroke survivors reduces this post-stroke cognitive decline and dementia, in people with and in those without diagnosed diabetes, Levine said.

Tight blood sugar control in people with diabetes is known to reduce small blood vessel complications in the eyes, kidneys and nerves. It might also reduce small blood vessel disease in the brain, the researchers suggested, though this is unproven.

People who have survived strokes and mini-strokes should work with their health care team to determine the best approach to testing and managing blood sugar for them, according to the researchers. This is especially true if they have pre-diabetes or diabetes.

Very low blood sugar levels in older adults are also a risk for dementia and should be avoided, Levine said.

The study was funded by the U.S. National Institute in Aging and other sources. The results were published online May 17 in JAMA Network Open.

More information

The American Stroke Association has more on life after a stroke.

SOURCE: Michigan Medicine, news release, May 17, 2023

Higher Glucose Levels May Contribute to Faster Cognitive Decline in Stroke Survivors

Will this prompt your stroke hospital to create protocols for testing this and then followup protocols to prevent cognitive decline from happening? Or is your hospital incompetent in not even knowing about this?

Do you prefer your  doctor and hospital incompetence NOT KNOWING? OR NOT DOING?

Higher Glucose Levels May Contribute to Faster Cognitive Decline in Stroke Survivors

Higher cumulative glucose levels may contribute to faster cognitive decline in stroke survivors, representing a potential treatment target to preserve cognition after stroke, according to a study published in JAMA Network Open.

“Having a stroke increases a person’s risk of dementia up to 50-fold,

but we lack a comprehensive treatment approach that could reduce this risk, other than preventing a second stroke,” said Deborah A. Levine, MD, University of Michigan Medical School, Ann Arbor, Michigan. “These findings suggest that higher cumulative blood sugar levels after stroke contribute to faster cognitive decline, and hyperglycaemia after stroke, regardless of diabetes status, could be a potential treatment target to protect post-stroke cognition.”

Dr. Levine and colleagues evaluated associations of post-stroke systolic blood pressure (BP), glucose, and low-density lipoprotein (LDL) cholesterol levels with cognitive decline by conducting a meta-analysis of 4 US cohort studies (conducted 1971-2019) that included 982 dementia-free individuals (48.9% female; 29.4% Black).

The median age at incident stroke was 74.6 years. Cumulative mean post-stroke systolic BP and LDL cholesterol levels were not associated with any cognitive outcome. However, after accounting for cumulative mean post-stroke systolic BP and LDL cholesterol levels, higher cumulative mean post-stroke glucose level was associated with faster decline in global cognition (-0.04 points/y faster per each 10 mg/dL increase; P = .046) but not executive function or memory.

After restricting to 798 participants with apolipoprotein E4 (APOE4) data and controlling for APOE4 and APOE4 × time, higher cumulative mean post-stroke glucose level was associated with a faster decline in global cognition in models without and with adjustment for cumulative mean post-stroke systolic BP and LDL cholesterol levels (-0.05 points/y faster per 10 mg/dL increase, P = .01; -0.07 points/y faster per 10 mg/dL increase, P = .002) but not executive function or memory declines.

Dr. Levine noted that the new study suggests the need for clinical research to test whether tight glycaemic control in stroke survivors reduces post-stroke cognitive decline and dementia in those with and without diagnosed diabetes.

Tight glycaemic control has been shown in people with diabetes to reduce small blood vessel complications in the eyes, kidney, and nerves, and may have the potential to also decrease small blood vessel disease in the brain, but this is unproven.

Reference: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805003

SOURCE: Michigan Medicine - University of Michigan

Relation between improvement of glycemic control and reduction of major cardiovascular events in 15 cardiovascular outcome trials: a meta‐analysis with metaregression

Once again they missed the memo that WHO reclassified stroke in 2006, now a neurological disease not cardiovascular disease? 

If our researchers are out-of-date how do you think your stroke doctors are keeping up? Does your stroke hospital have a research analysis employee whose only job is to take stroke research and implement into interventions and train the staff in the latest? If not you don't have a stroke hospital.

The MACE definition is wrong.

Relation between improvement of glycemic control and reduction of major cardiovascular events in 15 cardiovascular outcome trials: a meta‐analysis with metaregression

Diabetes, Obesity and Metabolism — Giugliano D, Bellastella G, Longo M, et al. | April 08, 2020

A meta‐analysis with metaregression was conducted to disclose associations between reduction of HbA_1c levels and risk of major cardiovascular events (MACE) in all cardiovascular outcome trials (CVOTs) so far published in patients with type 2 diabetes (T2D). Researchers carried out an electronic search up to February 10, 2020 to ascertain eligible trials. They evaluated pooled summary estimates and 95% confidence intervals according to random effects model applying the Paule‐Mandel method; restricted maximum likelihood estimators were applied to calculate model parameters in the metaregression. This study included 15 CVOTs involving a total of 138,250 patients. In CVOTs, the blood glucose reduction may play some role in lowering the risk of nonfatal stroke, at least during treatment with GLP‐1 RAs, without influencing the other two components of MACE.

• See Also: Cardiac magnetic resonance for asymptomatic patients with type 2 diabetes and cardiovascular high risk (CATCH): A pilot study

Read the full article on Diabetes, Obesity and Metabolism

Study: Tree nut consumption linked to improved type 2 diabetes health

You'll have to ask your doctor if the benefits from this apply to stroke survivors. Notice that peanuts are not included. But your doctor can analyze these two(when pigs fly) and come up with a diet protocol. You do expect not to have to do your doctors' work along with all your recovery rehab?

Eating peanuts may lead to supple arteries and healthy hearts  May 2017 

Study: Tree nut consumption linked to improved type 2 diabetes health May 2018

One of the largest studies to date on nuts and diabetes was published today in Diabetologia, the journal of the European Association for the Study of Diabetes (EASD). The study shows that approximately two ounces of nuts a day, as a replacement for carbohydrate foods, can improve glycemic control and blood lipids in those with type 2 diabetes.

Researchers from the University of Toronto and St. Michael's Hospital in Toronto, Canada, found that tree nuts (almonds, Brazils, cashews, hazelnuts, pecans, pine nuts, pistachios, macadamias and walnuts) and peanuts improved blood lipid levels and blood sugar levels in individuals with non-insulin dependent diabetes.

This study, which was retracted by the authors at their request, was originally published in Diabetes Care. It was a 3-month parallel design with 117 non-insulin dependent adults with diabetes (men and women with a mean age of 62 years) who were all being treated with oral hypoglycemic medications. The subjects were randomized to one of three diets for three months. The first diet included a supplement of 75g (~2½ ounces or ½ cup) of mixed nuts; the second diet included 38g (~1? ounces or ¼ cup) of mixed nuts and half portion of whole wheat muffins; and the third diet contained a full portion of whole wheat muffins.

Each supplement provided approximately 475 calories per 2,000 calorie diet. All of the diets contained roughly the same number of calories, but the nuts provided more unsaturated (i.e. healthy) fat and less carbohydrate.

The goal of the study was to determine if nuts improve glycemic control in non-insulin dependent diabetes, as assessed by HbA1c (a marker of blood sugar control over the previous three months), and also improve markers of cardiovascular health.

"The original findings revealed that the full dose nut group had a significant reduction in HbA1c compared to the other two groups," stated David Jenkins, MD, PhD, DSc, with the University of Toronto and St. Michael's Hospital. "The current study shows a reduction in HbA1c and the low-density lipoprotein (LDL)-associated cardiovascular disease (CVD) risk factor, apolipoprotein B (Apo-B), stated Dr. Jenkins. "We also found lower levels of small LDL cholesterol-- which is an emerging risk factor for CVD." He added, "The bottom line is, this study showed a modest but significant improvement in blood glucose control, despite the higher fat intake, and improvement in lipid risk factors for heart disease with increasing nut dose."

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According to Cyril Kendall, Ph.D., co-investigator of the study, "The improvements in blood glucose control and blood lipid levels that can be achieved by dietary and lifestyle changes are significant and could make a substantial contribution to the treatment of those with type 2 diabetes. Nuts are a healthy and flavorful option for individuals with diabetes that also promote healthy body weight."

A number of studies have suggested that consuming tree nuts may reduce the risk of heart disease, confirmed by the PREDIMED trial in 2013. In 2003 tree nuts received a qualified health claim from the U.S. Food and Drug Administration (FDA) which states, "Scientific evidence suggests but does not prove that eating 1.5 ounces per day of most nuts, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease." Interestingly, adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes.

According to Maureen Ternus, M.S., R.D., Executive Director of the International Tree Nut Council Nutrition Research & Education Foundation (INC NREF), "While we've known for years that eating nuts every day can help reduce the risk for heart disease, these findings show that consuming nuts may be helpful in controlling type 2 diabetes as well."

The original study was published in 2011 but retracted as the statistical model used did not control for repeated measures in the same individual. The current study fixed the previous statistical error and added new data of interest including LDL particle size and clotting factors.

Source:

https://www.easd.org/