Abstract
BackgroundGlycated hemoglobin (HbA1c) is a commonly used indicator of glycemic control in diabetes mellitus. Uncontrolled diabetes can lead to cardiovascular complications. Ischemic strokes are often complicated by hemorrhagic transformation, which is the conversion of an infarcted area into an area of hemorrhage. The purpose of this study is to determine the association of raised HbA1c levels with the occurrence of hemorrhagic transformation in ischemic stroke.MethodsThis is a prospective, single-center cohort study of patients admitted to the Neurology and Medicine wards between June 1 and November 30, 2019. Inclusion criteria included adult patients who were admitted with acute ischemic stroke and had been tested for HbA1c on presentation. There were 110 ischemic stroke patients enrolled in our database. An HbA1c level >53 mmol/mol was considered raised. A comparison was done between the group with raised HbA1c levels and the group with target levels of HbA1c for the occurrence of hemorrhagic transformation. Brain imaging was used to diagnose hemorrhagic transformation.ResultsOut of 110 study participants with ischemic stroke, 70 (63.6%) patients had a history of prior known diabetes. The mean HbA1c levels were 7.44 ± 1.79%. A total of 77% of diabetic patients had raised HbA1c levels (>7%). Hemorrhagic transformation was seen in 21 (19.1%) patients, of whom only 38% (n=8) had raised HbA1c levels. The association between raised HbA1c and hemorrhagic transformation was not found to be statistically significant (p = 0.225).ConclusionIn this study of patients with ischemic stroke, raised HbA1c levels were not found to be associated with hemorrhagic transformation. There is a need for larger scale studies to find out the cause and mechanism of hemorrhagic transformation in ischemic stroke.
Highlights
Diabetes mellitus is a chronic non-communicable disease with a rising global prevalence, causing widespread disability and death [1]
There is a need for larger scale studies to find out the cause and mechanism of hemorrhagic transformation in ischemic stroke
The purpose of our study is to determine the association of raised HbA1c levels with the occurrence of hemorrhagic transformation in ischemic stroke, so that physicians can be more vigilant in maintaining glycemic control and detecting hemorrhagic conversion in patients with uncontrolled diabetes
Summary
Diabetes mellitus is a chronic non-communicable disease with a rising global prevalence, causing widespread disability and death [1]. Cardiovascular diseases are the most common cause of morbidity and mortality in diabetic patients [2,3]. There is an increased risk of stroke in patients with diabetes [2]. Poor glycemic control prior to ischemic stroke is an independent risk factor for higher mortality, increased stroke severity and unfavorable long-term functional outcomes [5]. Acute ischemic stroke is sometimes complicated by hemorrhagic transformation, which is bleeding into an area of ischemic brain after a stroke that can cause increased morbidity and mortality. Hemorrhagic transformation occurs in as many as 10% to 15% of patients with ischemic stroke [6]. Ischemic strokes are often complicated by hemorrhagic transformation, which is the conversion of an infarcted area into an area of hemorrhage. The purpose of this study is to determine the association of raised HbA1c levels with the occurrence of hemorrhagic transformation in ischemic stroke
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