Abstract P616: Characterization of the Associations Between Pre-Diabetes and Diabetes With Occurrence of Stroke by Its Types, Subtypes and Outcomes Among West Africans

Abstract

Background: Pre-diabetes and diabetes mellitus (DM) are dysglycemic states associated with stroke occurrence. However, there is limited data from sub-Saharan Africa on the burden and associations between pre-DM and DM and stroke occurrence in a region experiencing an astronomic rise in stroke burden Purpose: To characterize the associations between stroke occurrence, types, subtypes, severity and outcome indicators according to glycemic 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 evidence of an acute stroke. Controls were age-and-gender matched stroke-free adults. Detailed evaluations for vascular, lifestyle, psychosocial factors, stroke severity and outcomes were performed. 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. The frequencies of euglycemia, pre-DM and DM among age- and sex-matched stroke-free controls were 69.2%, 13.3% and 17.5% respectively. Pre-diabetes was independently associated with stroke, adjusted odds ratio (95% CI) of 3.68 (2.61 - 5.21) as was having DM, aOR of 4.29 (3.19 - 5.74). The effect size of Pre-DM for ischemic stroke of 3.06 (95% CI: 2.01 - 4.64) was lower than that for DM of 4.82 (3.37-6.89). However, the effect size of Pre-DM for hemorrhagic stroke of 6.81 (95% CI: 3.29 - 14.08) is higher than 3.36 (1.94 - 5.86) for DM. Furthermore, the effect sizes of pre-DM for ischemic stroke subtypes were 9.64 (95% CI: 1.30-71.57) for cardio-embolic stroke, 3.64 (95% CI: 1.80-7.34) for small-vessel occlusive disease and 4.63 (95% CI: 0.80-26.65) for large-vessel disease. Conclusion: Every 2 out of 3 stroke cases admitted had a blood glucose abnormality. In addition to confirming the known associations between DM and stroke occurrence, we demonstrate that pre-DM is independently and more potently associated with hemorrhagic than ischemic strokes among West Africans.