Diabetes & Metabolism Journal

Original Articles

Higher Glycated Hemoglobin Level Is Associated with Increased Risk for Ischemic Stroke in Non-Diabetic Korean Male Adults: Hyung Geun Oh, Eun-Jung Rhee, Tae-Woong Kim, Kyung Bok Lee, Jeong-Ho Park, Kwang-Ik Yang, Dushin Jeong, Hyung-Kook Park; Diabetes Metab J. 2011;35(5):551-557. Published online October 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.5.551

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Background

The role of glycated hemoglobin (HbA1c) in the prediction of ischemic stroke in non-diabetic subjects is not clear. We performed a study to analyze the role of HbA1c in the risk prediction of ischemic stroke in non-diabetic Korean males adult.

Methods

A total of 307 non-diabetic male patients with ischemic stroke were enrolled, and 253 age-matched control subjects without a history of diabetes, hypertension, or cardiovascular disease were selected from a Health Check-up database. Anthropometric measurement data, fasting glucose level, lipid profile, and HbA1c level were available for all subjects. Associations of the variables and the presence or absence of ischemic stroke were analyzed.

Results

The ischemic stroke patient group had significantly higher HbA1c levels (5.8±0.5% vs. 5.5±0.5%, P<0.01) and mean systolic and diastolic blood pressure compared with the control group. Among the variables, smoking, low high density lipoprotein cholesterol, systolic blood pressure, and HbA1c were the significant determinants for ischemic stroke. The highest quartile of HbA1c showed a 9.6-fold increased odds ratio for ischemic stroke compared with the lowest quartile of HbA1c (odds ratio, 9.596; 95% confidence interval, 3.859 to 23.863, P<0.01). The proportion of ischemic stroke patients showed a significant trend for increment as the deciles of HbA1c increased (P for trend <0.01).

Conclusion

Higher HbA1c indicated a significantly increased risk for ischemic stroke after adjusting for other confounding variables in non-diabetic Korean adult males. HbA1c might have significance in predicting the risk for ischemic stroke even in the non-diabetic range.

Citations

Citations to this article as recorded by

Association of Glycated Hemoglobin With Acute Ischemic Stroke in a Tertiary Care Center in a Tribal Region of Jharkhand
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Machine learning algorithms identify demographics, dietary features, and blood biomarkers associated with stroke records
Jundong Liu, Elizabeth L. Chou, Kui Kai Lau, Peter Y.M. Woo, Jun Li, Kei Hang Katie Chan
Journal of the Neurological Sciences.2022; 440: 120335. CrossRef
HbA1c and clinical outcomes after endovascular treatment in patients with posterior circulation large vessel occlusion: a subgroup analysis of a nationwide registry (BASILAR)
Feixue Yue, Zhongxiu Wang, Jie Pu, Min Zhang, Yong Liu, Hongxing Han, Wenhua Liu, Xianjun Wang, Rongzong Li, Dongzhang Xue, Jiaming Cao, Zhizhong Yan, Guozhong Niu, Hao Zhang, Haitao Guan, Hongliang Zeng, Feng You, Qian Yang, Wenjie Zi, Yi Zhang, Zetao Sh
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Mortality and cardiovascular disease burden of uncontrolled diabetes in a registry-based cohort: the ESCARVAL-risk study
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European Journal of Medical Research.2017;[Epub] CrossRef
Early New Ischemic Lesions Located Outside the Initially Affected Vascular Territory Appear More Often in Stroke Patients with Elevated Glycated Hemoglobin (HbA1c)
Tim Bastian Braemswig, Christian H. Nolte, Jochen B. Fiebach, Tatiana Usnich
Frontiers in Neurology.2017;[Epub] CrossRef
Blood Pressure Is the Determinant for the Increased Risk for Intracranial Arterial Stenosis in Subjects with Elevated Glycated Hemoglobin Levels: The Kangbuk Samsung Health Study
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Journal of Stroke and Cerebrovascular Diseases.2016; 25(11): 2729. CrossRef
Prognosis of Ischemic Stroke With Newly Diagnosed Diabetes Mellitus According to Hemoglobin A1c Criteria in Chinese Population
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Stroke.2016; 47(8): 2038. CrossRef
The Impact of Diabetes Mellitus and Corresponding HbA1c Levels on the Future Risks of Cardiovascular Disease and Mortality: A Representative Cohort Study in Taiwan
Yun-Yu Chen, Yenn-Jiang Lin, Eric Chong, Pei-Chun Chen, Taz-Fan Chao, Shih-Ann Chen, Kuo-Liong Chien, An Pan
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So Ra Yoon, Jae Hyang Lee, Ga Yoon Na, Yu Jeong Seo, Seongho Han, Min-Jeong Shin, Oh Yoen Kim
Clinical Nutrition Research.2015; 4(2): 97. CrossRef
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Diabetes & Metabolism Journal.2014; 38(1): 58. CrossRef
Glycated Hemoglobin and All-Cause and Cause-Specific Mortality in Singaporean Chinese Without Diagnosed Diabetes: The Singapore Chinese Health Study
Michael P. Bancks, Andrew O. Odegaard, James S. Pankow, Woon-Puay Koh, Jian-Min Yuan, Myron D. Gross, Mark A. Pereira
Diabetes Care.2014; 37(12): 3180. CrossRef
Letter: Higher Glycated Hemoglobin Level Is Associated with Increased Risk of Ischemic Stroke in Non-Diabetic Korean Male Adults (Diabetes Metab J 2011;35:551-7)
Seok Hong Lee, Jihyun Ahn, Jaetaek Kim
Diabetes & Metabolism Journal.2012; 36(1): 79. CrossRef

Relations between Insulin Resistance and Hematologic Parameters in Elderly Koreans: Southwest Seoul (SWS) Study.: Kye Won Lee, Hye Jin Yoo, Soo Yeon Park, Ohk Hyun Ryu, Sang Soo Park, Soon Beom Kwon, Hee Young Kim, Ji A Seo, Jeong Heon Oh, Dong Hyun Shin, Sin Gon Kim, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Hyoung Jin Kim; Korean Diabetes J. 2003;27(4):352-361. Published online August 1, 2003

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Abstract PDF: BACKGROUND
The clustering of cardiovascular risk factors is known as insulin resistance syndrome. Hyperinsulinemia has been suggested as a cardiovascular risk factor due to the capacity of insulin to induce vascular endothelial proliferation and atherosclerosis. Insulin also has been shown to stimulate erythroid colony formation independently of erythropoietin. WBC count is one of the major components of the inflammatory process and is increased by IL-6, which is high in those with features of insulin resistance. In this study, we investigated whether insulin resistance affects hematological parameters. METHODS: In this study, 1,314, randomly selected, non-diabetic, elderly subjects over 60 years living in the southwest area of Seoul were recruited. Subjects underwent 75 g OGTT and careful physical examinations during evaluation, and were interviewed using a standardized questionnaire. Biochemical data and hematologic parameters were also measured. Insulin resistance was calculated by HOMA (homeostasis model assessment) method. Analysis of variance, Duncan's multiple comparisons and multiple linear regression analysis were carried out. RESULTS: In the male non-smoking group we found a correlation between insulin resistance and hemoglobin concentration (r=0.20, p=0.0186). In the female non- smoking group we found correlations between insulin resistance and both hemoglobin concentration (r=0.10, p=0.0017) and white blood cell (WBC) count (r=0.15, p=0.001). Hemoglobin concentration and WBC count were also correlated with BMI, systolic and diastolic blood pressure, lipid profiles and fasting insulin levels in female non-smokers. In multiple regression analysis, using HOMA IR as a dependent variable, we found significance in the variables of hemoglobin concentration, WBC count, age, BMI and triglyceride level. CONCLUSION: Our study provided evidence for a relation between insulin resistance and hematological parameters such as hemoglobin concentration and WBC count in elderly Koreans. This suggests that increased hemoglobin level and WBC count could be considered as novel aspects of the met.

The Frequency of ICA and anti-GAD Antibody in Korean IDDM and NIDDM Patients.: Kyung Soo Ko, Sung Kwan Hong, Ki Up Lee, Nan Hee Kim, Dong Seop Choi, Sung Hee Ihm, Sung Woo Park, Chul Hee Kim, Dong Won Byun, Kyo Il Suh, Hak Chul Chang, Byoung Doo Rhee; Korean Diabetes J. 1998;22(3):312-319. Published online January 1, 2001

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Abstract PDF: BACKGROUND
It has been suggested that the clinical and immunological characteristics of diabetes mellitus in Koreans are different from those of Caucasians. This study was undertaken to investigate the prevalence of autoimmune markers in Korean adults with IDDM and recent-onset NIDDM. METHODS: Seventy-seven Korean adults with IDDM and 245 recently(within 2 years) diagnosed NIDDM were included in the study. Islet cell cytoplasmic antibody was measured by immunohistochemical method, and anti-glutamic acid decarboxylase (anti-GAD) antibody was measured by radioimmunoassay. RESULTS: 1) The prevalence of ICA, anti-GAD antibody positivity was 27% and 40% in IDDM patients, and 5% and 4% in recent-onset NIDDM patients, respectively. 2) The prevalence of ICA positivity in IDDM patients decreased from 42% within one year to 21% over one year after clinical onset of disease. On the other hand, the positivity of anti-GAD antibody did not change according to the duration of diabetes. 3) The prevalence of ICA tends to be lower in IDDW patients with low serum C-peptide concentrations. In contrast, the prevalence of anti-GAD antibody was not different according to sernm C-peptide levels. CONCLUSION: These results suggested that the prevalence of ICA and antii-GAD antibody was lower in Korean adult IDDM and recent-onset NIDDM patients than that in Caucasians.

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