Recent glycemic control can predict the progressive motor deficits of acute subcortical infarction with diabetes or prediabetes

초록

Background and purpose The predictors of progressive motor deficits in acute subcortical infarctions are still controversial. It is not known whether glycemic control influences on stroke progression. Methods A total of 268 consecutive patients with diabetes or prediabetes who had acute (< 24 h) subcortical infarction were enrolled. (1) All patients were divided into 4 groups by quartile of glycated hemoglobin (HbA1c). (2) Only the patients with diabetes were divided by effective glycemic control. Progressive motor deficits were prospectively captured and defined as an increase of motor score >= 1 on the upper or lower limb items of the National Institute of Health Stroke Scale within 72 h from stroke onset. Results Progressive motor deficits occur in 8/78 (10.3%) for <= 5.9, 15/61 (24.6%) for 6.0-6.4, 16/62 (25.8%) for 6.5-7.4, and 30/67 (44.8%) for >= 7.5. In diabetic patients alone, those occur in 5/37 (13.5%) for <= 6.5, 10/42 (23.8%) for 6.6-7.0, 12/42 (28.6%) for 7.1-8.0, and 24/50 (48.0%) for >= 8.1. An adjusted OR of progressive motor deficits was 2.61 (95% confidence interval [CI] 0.98-7.00,P = .056) for 6.0-6.4, 3.42 (95% CI 1.27-9.18,P = .015) for 6.5-7.4, and 6.65 (95% CI 2.38-18.62,P< .001) for >= 7.5. In diabetic patients alone, those were 3.15 (95% CI 0.89-11.15,P = .075) for 6.6-7.0, 2.90 (95% CI 0.79-10.61,P = .107) for 7.1-8.0, and 4.17 (95% CI 1.07-16.25,P = .038) for >= 8.1. The optimal cutoff value of HbA1c was 6.65% in discriminating progressive motor deficits. Conclusion Increased HbA1c was associated with higher incidence of progressive motor deficits in acute subcortical infarction with diabetes and prediabetes.

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