Associations of diabetes status and glucose measures with outcomes after endovascular therapy in patients with acute ischemic stroke: an analysis of the nationwide TREAT-AIS registry

Abstract

Background: Hyperglycemia affects the outcomes of endovascular therapy (EVT) for acute ischemic stroke (AIS). This study compares the predictive ability of diabetes status and glucose measures on EVT outcomes using nationwide registry data.

Methods: The study included 1,097 AIS patients who underwent EVT from the Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke. The variables analyzed included diabetes status, admission glucose, glycated hemoglobin (HbA1c), admission glucose-to-HbA1c ratio (GAR), and outcomes such as 90-day poor functional outcome (modified Rankin Scale score ≥ 2) and symptomatic intracranial hemorrhage (SICH). Multivariable analyses investigated the independent effects of diabetes status and glucose measures on outcomes. A receiver operating characteristic (ROC) analysis was performed to compare their predictive abilities.

Results: The multivariable analysis showed that individuals with known diabetes had a higher likelihood of poor functional outcomes (odds ratios [ORs] 2.10 to 2.58) and SICH (ORs 3.28 to 4.30) compared to those without diabetes. Higher quartiles of admission glucose and GAR were associated with poor functional outcomes and SICH. Higher quartiles of HbA1c were significantly associated with poor functional outcomes. However, patients in the second HbA1c quartile (5.6-5.8%) showed a non-significant tendency toward good functional outcomes compared to those in the lowest quartile (<5.6%). The ROC analysis indicated that diabetes status and admission glucose had higher predictive abilities for poor functional outcomes, while admission glucose and GAR were better predictors for SICH.

Conclusion: In AIS patients undergoing EVT, diabetes status, admission glucose, and GAR were associated with 90-day poor functional outcomes and SICH. Admission glucose was likely the most suitable glucose measure for predicting outcomes after EVT.

Keywords: acute ischemic stroke; diabetes; endovascular therapy; outcomes; plasma glucose.

Figure 1

The effects of diabetes status (A) and glucose measures (B–D) on 90-day functional outcomes in univariable (Model 1) and multivariable logistic regression analyses (Model 2: adjusted for age, sex, and NIHSS score; Model 3: adjusted for age, sex, NIHSS score, and reperfusion success; Model 4: adjusted for age, sex, NIHSS score, reperfusion success, and last known well to reperfusion time). CI, confidence interval; GAR, glucose-to-HbA1c ratio; HbA1c, glycated hemoglobin; OR, odds ratio.

Figure 2

The effects of diabetes status (A) and glucose measures (B–D) on symptomatic intracranial hemorrhage in univariable (Model 1) and multivariable logistic regression analyses (Model 2: adjusted for age, sex, and NIHSS score; Model 3: adjusted for age, sex, NIHSS score, and reperfusion success; Model 4: adjusted for age, sex, NIHSS score, reperfusion success, and last known well to reperfusion time). CI, confidence interval; GAR, glucose-to-HbA1c ratio; HbA1c, glycated hemoglobin; OR, odds ratio; SICH, symptomatic intracranial hemorrhage.