Diabetes and Stroke: The Role of Glucose Regulation
The relationship between stroke and diabetes mellitus (DM) though complex is undeniable. Numerous studies have delineated a clear correlate between prediabetes, diabetes mellitus type 1, and diabetes mellitus type 2 as they relate to cerebrovascular disease with decades of research detailing the causality between hyperglycemia and stroke risk. The global prevalence of stroke continues to rise despite the advances in treatment options for cardiovascular risk factor modification such as diabetes. Diabetics represent a subset of the patients who are at two to three times higher risk for mortality from stroke than the general population . The purpose of this chapter is to detail the microvascular and macrovascular mechanisms that promote cerebrovascular disease in diabetics which leads to stroke. Additionally, the importance of glucose control for both primary and secondary stroke prevention will be discussed in terms of the role of therapeutical options for attaining normoglycemia. Finally, there will be in-depth discussion of the optimization of diabetic control as it relates to other stroke risk factors such as atherosclerosis, hypertension, and atrial fibrillation.
KeywordsMacrovascular Microvascular – primary stroke prevention Secondary stroke prevention Recurrent stroke prevention
We would like to thank Dr. Tarun Girotra for his generous inputs and comments to this book chapter. Dr. Feng would like to acknowledge grant supports from the National Institutes of Health (P20GM109040 and HD086844), from the American Heart Association (14SDG1829003), and from the South Carolina Clinical and Translational Research Institute (UL1 TR001450).
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