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Association between hemoglobin A1c and acute ischemic stroke among patients with type-2 diabetes: a case-control study

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International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Background

At present, stroke is a major health burden and the leading cause of death and long-term disability in the elderly. Ischemic stroke is the most common stroke type in the Thai population. Causes of ischemic stroke are likely to be multifactorial.

Objective

The purpose of this study was to determine the association between hemoglobin A1c (HbA1c) and acute ischemic stroke (AIS) among Thai patients with type-2 diabetes (PTDs).

Methods

A hospital-based case-control study was conducted among PTDs attending the Bhuddasothorn hospital with 100 cases and 300 controls from 2013 to 2016. Cases were defined as PTDs who had an AIS and diagnosed by neurologists and computed tomography (CT) scan and controls were PTDs who did not have AIS. Cases and controls were matched by gender, age (± 5 years), residential area, and attending duration. Data were collected using a questionnaire comprising 2 parts: demographic characteristics and medical data.

Results

Conditional logistic regression was applied to estimate the effect of HbA1c on acute ischemic stroke among PTDs. Univariable conditional logistic regression showed risk factors for AIS among the PTDs comprised history of dyslipidemia, history of atrial fibrillation, diastolic blood pressure, systolic blood pressure, HbA1c, history of CVD, FPG, creatinine, and microvascular complications (p < 0.05). For multivariable conditional logistic regression, after controlling for potential confounders, it revealed a HbA1c of 8–8.9% and higher increased the risk of AIS by a factor of 7.9 and 10.9 times, respectively (OR = 7.9, 95%CI = 3.0–20.9; OR = 10.9, 95%CI = 4.3–27.9).

Conclusions

Ongoing surveillance of HbA1c among PTDs should be conducted alongside knowledge sharing of glycemic control and stroke prevention as an essential measure to prevent developing AIS risk.

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Acknowledgments

The authors would like to express their thanks to the participants and staff for their cooperation and participation in the study, and also wish to extend our deep appreciation to those who are not mentioned here for their kindness and encouragement. This study was supported for publication by the Faculty of Public Health, Mahidol University, Bangkok, Thailand.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Faculty of Public Health, Mahidol University, Ratchathewi, Bangkok, 10400, Thailand

    Wisit Chaveepojnkamjorn

  2. Bangpakong Health Office, Bangpakong District, Chachoengsao, Thailand

    Wandee Boorasri

  3. Department of Biostatistics, Faculty of Public Health, Mahidol University, Ratchathewi, Bangkok, Thailand

    Chukiat Viwatwongkasem

  4. Department of Epidemiology, Faculty of Public Health, Mahidol University, Ratchathewi, Bangkok, Thailand

    Sukontha Siri

  5. Bhuddasothorn Hospital, Muang District, Chachoengsao, Thailand

    Warakorn Krienkaisakda

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  1. Wisit Chaveepojnkamjorn
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Contributions

W.C. carried out the data collection and drafted the manuscript. W.B. undertook the literature searches. All authors conceived the study idea, participated in its design, and performed the statistical analyses. All authors have read and approved the final version to be published.

Corresponding author

Correspondence to Wisit Chaveepojnkamjorn.

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Conflict of interest

The authors declare that they have no conflict of interest on finance and non-finance.

Ethical approval

The study protocol was reviewed and approved by the Ethics Committee for Research in Human Subjects of the Faculty of Public Health, Mahidol University (171/2557), the Ethics Committee for Research in Human Subjects of the Chachoengsao Public Health Office (PH_CCO_REC 004/58), and the Ethics Committee for Research of the Bhuddasothorn hospital (BSH-IRB 005/2558). The information was collected using medical records. Confidentiality was well maintained using an anonymous technique throughout the study to ensure privacy and the results were analyzed as a whole group.

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Informed consent was obtained from all individual participants included in the study.

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Chaveepojnkamjorn, W., Boorasri, W., Viwatwongkasem, C. et al. Association between hemoglobin A1c and acute ischemic stroke among patients with type-2 diabetes: a case-control study. Int J Diabetes Dev Ctries 40, 555–560 (2020). https://doi.org/10.1007/s13410-020-00806-7

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  • DOI: https://doi.org/10.1007/s13410-020-00806-7

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