Published: 2017-03-23

Study of the severity of stroke at the time of presentation in diabetic patients correlating with glycemic control

Sivaji Patibandla, Tumbanatham Appikatla, Jayasingh K.


Background: Diabetes mellitus is a well-recognized risk factor for stroke. The NIHSS (National institute of health stroke scale) is a tool used objectively to quantify the impairment caused by a stroke. However, the effect of glycemic control regardless of the presence of DM on the clinical picture of stroke and its impact on the severity is not fully investigated. There are numerous studies on microvascular complications but there are only a few studies on strokes in diabetics. Therefore, this study was conducted to assess the impact of diabetes on the pattern and severity of stroke in our population.

Methods: This is cross sectional observational study, carried at Mahatma Gandhi Medical College And Research Institute, Pondicherry, India from December 2014-15. Sixty patients who presented with features of stroke and satisfy inclusion criteria were enrolled in study. Stroke pattern was identified using CT scan and severity of stroke was assessed by NIHSS score. Statistical analysis was done by using chi-square test (p <0.005 = significant).

Results: The mean age in patients was 61.683±12.97. The ratio of male to female was 2.1:1 showing male preponderance. With increase in HbA1c levels more number of cases were found to have severe stroke and it is statically significant (p = 0.0001) as per NIHSS score.

Conclusions: In diabetic patients the severity of stroke is related to glycemic control. Higher the blood HbA1c level, more severe is the neurological impairment. Hence effective lowering of HbA1c level may reduce the occurrence of severe neurological impairment in diabetic patients. We suggest the need for routine monitoring of HbA1c level may be used as a measure for secondary prevention of stroke in diabetic patients.


Diabetes mellitus, Glycemic control, NIHSS, Stroke, Stroke severity

Full Text:



Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53.

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2095-128.

Kothari V, Stevens RJ, Adler AI, Stratton IM, Manley SE, Neil HA, et al. UKPDS 60: Risk of stroke in type 2 diabetes estimated by the UK prospective diabetes study risk engine. Stroke. 2002;33(7):1776-81.

Kissela BM, Khoury J, Kleindorfer D, Woo D, Schneider A, Alwell K, et al. Epidemiology of ischemic stroke in patients with diabetes: the greater cincinnati/northern kentucky stroke study. Diabetes Care. 2005;28(2):355-9.

Mulnier HE, Seaman HE, Raleigh VS, Muthu SS, Colhoun HM, Lawrenson RA, et al. Risk of stroke in people with type 2 diabetes in the UK: a study using the general practice research database. Diabetologia. 2006;49(12):2859-65.

Grau AJ, Weimar C, Buggle F, Heinrich A, Goertler M, Neumaier S, et al. Risk factors, outcome, and treatment in subtypes of ischemic stroke: the german stroke data bank. Stroke. 2001;32(11):2559-66.

Megherbi SE, Milan C, Minier D, Couvreur G, Osseby GV, Tilling K, et al. Association between diabetes and stroke subtype on survival and functional outcome 3 months after stroke: data from the European BIOMED stroke project. Stroke. 2003;34(3):688-94.

Zafar A, Shahid SK, Siddiqui M, Khan FS. Pattern of stroke in type 2 diabetic subjects versus non diabetic subjects. J Ayub Med Coll Abbottabad. 2007;19(4):64-7.

Kamel A, Azim HA, Aziz SA, Ghaffar A, Okeely AE. Cerebral infarction in diabetes mellitus: A comparative study of diabetic and non-diabetic ischemic stroke. Egypt J Neurol Psychiat Neurosurg. 2006;43(1):167-77.

Sarkar RN, Banerjee S, Basu A. Comparative evaluation of diabetic and non-diabetic stroke-effect of glycaemia on outcome. J Indian Med Assoc. 2004;102(10):551-3.

Ho JE, Paultre F, Mosca L. Is diabetes mellitus a cardiovascular disease risk equivalent for fatal stroke in women? Stroke. 2003;34(12):2812-6.

Farooq MU, Majid A, Reeves MJ, Birbeck GL. The epidemiology of stroke in Pakistan: past, present, and future. Int J Stroke. 2009;4(5):381-9.

Allport LE, Butcher KS, Baird TA, Macgregor L, Desmond PM, Tress BM, et al. Insular cortical ischemia is independently associated with acute stress hyperglycemia. Stroke. 2004;35(8):1886-91.

Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients. Stroke. 2001;32(10):2426-32.

Ogbera AO, Oshinaike OO, Dada O, Mends BA, Ekpebegh C. Glucose and lipid assessment in patients with acute stroke. Int Arch Med. 2014;7(1):1.

Murros K, Fogelholm R, Kettunen S, Vuorela AL, Valve J. Blood glucose, glycosylated haemoglobin, and outcome of ischemic brain infarction. J Neurol Sci. 1992;111(1):59-64.

Tuomilehto J, Rastenyte D, Jousilahti P, Sarti C, Vartiainen E. Diabetes mellitus as a risk factor for death from stroke : prospective study of the middle-aged finnish population. Stroke. 1996;27(2):210-5.

Kizer JR, Wiebers DO, Whisnant JP, Galloway JM, Welty TK, Lee ET, et al. Glycemic level and future stroke in type 2 diabetes mellitus: the strong heart study. Circulation. 2006;114(18):444.

Shuangxi G, Song T, Bo S, Avinash C, Anna M, Hui F, et al. Study of the relationship of glycated hemoglobin levels and neurological impairment and three months prognosis in patients with acute ischemic stroke. Life Sci J. 2012;9(2):119-21.

Kamouchi M, Matsuki T, Hata J, Kuwashiro T, Ago T, Sambongi Y, et al. Prestroke glycemic control is associated with the functional outcome in acute ischemic stroke. Stroke. 2011;42(10):2788-94.