Glycemic control in patients with cerebrovascular diseases and type 2 diabetes mellitus

Aim

To evaluate an impact of glucose control on the course of acute and chronic cerebrovascular diseases (CVD) in type 2 diabetic patients.

Material and methods

We enrolled in our study 52 patients with acute CVD and 51 patients with chronic CVD, all in the setting of type 2 diabetes. Glycemic control was evaluated by glycemia and glycated hemoglobin levels. All patients underwent brain magnetic resonance imaging and ultrasonography of the brachiocephalic arteries.

Results

Ninety percent of patients with acute CVD had ischemic stroke (atherothombotic in origin in the majority of patients). Approximately half of type 2 diabetic patients presented with atherosclerotic changes both in carotid and vertebral arteries. Significant stenosis or occlussion of cerebral arteries were found in one third of patients. There was a direct correlation between the duration of type 2 diabetes and the severity of carotid atherosclerosis. НbA1c levels exceeded 7.0% in 58% of patients with acute stroke and in 68% of patients with chronic CVD. Mean HbA1c in patients with stroke was higher compared with that in patients with chronic CVD. An inverse correlation was found between the НbA1c level and regress of the neurological symptoms. In patients with acute stroke, hypoglycemic events were usually asymptomatic.

Conclusion

CVD in patients with type 2 diabetes mellitus is associated with carotid atherosclerosis progression, chronic hyperglycemia and HbA1c elevation. HbA1c level may predict stroke and should be routinely measured in patients with CVD.

Key words

Cerebrovascular diseases, stroke, atherosclerosis, diabetes mellitus type 2, glycemic control, glycated hemoglobin.