Table 1.
Characteristics of the studies included in the meta-analysis (for acute ischemic stroke).
| References | Study design | Country | Participant characteristics | Sample size | Exposure variable of interest | Key outcome |
|---|---|---|---|---|---|---|
| Diprose et al. (19) | Prospective follow-up | New Zealand | Patients undergoing endovascular thrombectomy for ischemic stroke Mean (SD) age: 64.5 (14.6) years; 61% males |
223 | HbA1c as continuous variable | 3-month mortality: OR 1.26 (95% CI: 1.01, 1.57) 3-month functional dependence: OR 1.32 (95% CI: 1.04, 1.67) 24-h neurological deterioration: OR 1.16 (95% CI:0.95, 1.41) Successful reperfusion: OR 1.11 (95% CI: 0.83, 1.49) Symptomatic intracerebral hemorrhage: OR 1.33 (95% CI: 1.03, 1.71) |
| Jing et al. (20) | Prospective cohort study | China | Ischemic stroke patients enrolled in the “ACROSS-China” cohort Mean (SD) age of participants with no diabetes: 60.6 (12.8) years; 67% male participants Mean (SD) age of participants with HbA1c ≥ 6.5%: 64.2 (11.6) years; 68% male participants |
853 (712 with no diabetes; 141 with diabetes diagnosed as HbA1c ≥ 6.5%) | HbA1c ≥ 6.5% | 12-month mortality (N = 853): OR 1.02 (95% CI: 0.85, 1.22) 12-month stroke recurrence (N = 838): OR 1.03 (95% CI: 0.86, 1.24) 12-month poor functional outcome (N = 837): OR 1.19 (95% CI:0.74, 1.91) |
| Wang et al. (21) | Prospective follow-up study | China | Patients with first-ever ischemic stroke were enrolled and followed-up for neurological outcome assessment at 3 months post-stroke. Total sample of 408 subjects with mean (SD) age of 63.8 (11.5) years and 64% males |
Overall 408; Low HbA1c (153) Moderate HbA1c (126) High HbA1c (129) |
Low (<5.7%); moderate (5.7–6.4%) and high (≥6.5%) HbA1c values HbA1c as continuous variable |
Moderate HbA1c: 3-month poor functional outcome (N = 279): OR 1.79 (95% CI:1.01, 3.21) High HbA1c 3-month poor functional outcome (N = 282): OR 2.39 (95% CI:1.20, 4.74) Continuous HbA1c: 3-month poor functional outcome (N = 408): OR 1.38 (95% CI:1.08, 1.78) |
| Zhang et al. (22) | Prospective cohort | China | Patients with acute anterior circulation stroke; mean age was around 65 years and around 60% subjects were males | 426 subjects | HbA1c as continuous variable | Symptomatic intracerebral hemorrhage: OR 1.29 (95% CI: 1.09, 1.53) Poor functional outcome; short term: OR 1.48 (95% CI:1.23, 1.79) |
| Yang et al. (23) | Retrospective observational study | Taiwan | Patients with acute ischemic stroke Mean age was around 64 years and around 62% subjects were males |
309 subjects | HbA1c ≥ 7.0% | Mortality: OR 0.42 (95% CI: 0.16, 1.13) Poor functional outcome: OR 0.83 (95% CI: 0.51, 1.35) Neurological complications: OR 0.60 (95% CI: 0.35, 1.03) |
| Wu et al. (24) | Prospective cohort | China | Patients with acute ischemic stroke; mean age of subjects around 65 years and around 60% males | Total of 2,186 subjects | HbA1C categorized as: <5.5%; 5.5– <6.1%; 6.1– <7.2%, and ≥7.2% | Mortality within 1 year HbA1c 5.5–6.1% (N = 507): OR 1.07 (95% CI: 0.57, 2.01) HbA1c 6.1– <7.2% (N = 579): OR 1.01 (95% CI: 0.53, 1.86) HbA1c ≥ 7.2% (N = 560): OR 2.45 (95% CI: 1.30, 4.62) |
| Poor functional outcome at 3 months HbA1c 5.5–6.1% (N = 507): OR 1.57 (95% CI: 1.06, 2.33) HbA1c 6.1– <7.2% (N = 579): OR 1.30 (95% CI: 0.87, 1.93) HbA1c ≥ 7.2% (N = 560): OR 1.36 (95% CI: 0.84, 2.19) Poor functional outcome at 12 months HbA1c 5.5–6.1% (N = 507): OR 1.05 (95% CI: 0.63, 1.75) HbA1c 6.1– <7.2% (N = 579): OR 0.88 (95% CI: 0.54, 1.46) HbA1c ≥ 7.2% (N = 560): OR 1.20 (95% CI: 0.66, 2.19) |
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| Lattanzi et al. (25) | Retrospective cohort | Italy | Patients with acute ischemic stroke; mean age of subjects around 70 years and around 60% males | 112 subjects | HbA1C categorized as: <7.0% and ≥7.0% | Poor functional outcome at 3 months HbA1c ≥7.0%: OR 6.22 (95% CI: 1.94, 19.98) |
| Sunanda et al. (26) | Prospective case control study | India | Patients with acute ischemic stroke; mean (SD) age of subjects 56.7 (12.9) years; 72% males | 130 subjects | HbA1C categorized as: <7.0% and ≥7.0% | Poor functional outcome at 3 months HbA1c ≥ 7.0%: OR 19.4 (95% CI: 5.9, 63.2) |
| Choi et al. (27) | Prospective cohort | South Korea | Patients with acute ischemic stroke (large vessel occlusion) treated with mechanical thrombectomy; subjects around 69 years of age and nearly 50% male | 534 subjects | HbA1C categorized as: <6.5% and ≥6.5% | Poor functional outcome at 3 months HbA1c ≥ 6.5%: OR 2.22 (95% CI: 1.43, 3.45) Mortality within 3 months HbA1c ≥ 6.5%: OR 4.32 (95% CI: 2.41, 7.75) Symptomatic intracerebral hemorrhage HbA1c ≥ 6.5%: OR 1.50 (95% CI: 0.68, 3.30) Early neurological deterioration HbA1c ≥ 6.5%: OR 2.11 (95% CI: 1.31, 3.38) |
| Hjalmarsson et al. (28) | Retrospective analysis of patient data | Sweden | Patients with acute ischemic stroke; subjects around 75 years of age | 501 subjects |
HbA1C categorized as: ≤6.0% and >6.0% Continuous HbA1C |
Mortality within 12 months HbA1c > 6.0%: OR 3.40 (95% CI: 1.40, 8.22) Continuous HbA1c: OR 1.29 (95% CI: 1.03, 1.62) Poor functional outcome at 12 months HbA1c > 6.0%: OR 2.68 (95% CI: 1.14, 6.03) |
| Kamouchi et al. (29) | Both prospective and retrospective cohort; data from multicenter hospital-based registry | Japan | Patients with acute ischemic stroke; mean (SD) age of participants 69 (12) years and 37.7% were women | 3,627 subjects | HbA1C categorized as: Excellent (<6.2%) Good (6.2% to <6.9%) Fair (6.9% to <8.4%) Poor (≥8.4%) |
Short term outcomes Neurological deterioration: HbA1c ≥ 6.9%: OR 1.65 (95% CI: 1.31, 2.06) Mortality: HbA1c ≥ 6.9%: OR 1.20 (95% CI: 0.79, 1.84) Poor functional outcome: HbA1c ≥ 6.9%: OR 1.35 (95% CI: 1.16, 1.58) Additional findings: Neurological deterioration: HbA1c Good: OR 1.02 (95% CI: 0.70, 1.46) HbA1c Fair: OR 1.66 (95% CI: 1.12, 2.43) HbA1c Poor: OR 2.32 (95% CI: 1.39, 3.83) Mortality: HbA1c Good: OR 1.20 (95% CI: 0.60, 2.64) HbA1c Fair: OR 1.02 (95% CI: 0.46, 2.45) HbA1c Poor: OR 0.46 (95% CI: 0.16, 1.38) Poor functional outcome: HbA1c Good: OR 1.16 (95% CI: 0.90, 1.51) HbA1c Fair: OR 1.26 (95% CI: 0.94, 1.71) HbA1c Poor: OR 2.30 (95% CI: 1.56, 3.40) |
| Rocco et al. (30) | Retrospective single-center study | Germany | Patients with acute ischemic stroke Mean age of participants around 68 years and around 60% subjects were males |
112 subjects | Continuous HbA1c | Symptomatic intracerebral hemorrhage (within 24 h): OR 10.3 (95% CI: 3.89, 27.3) 3 month-mortality: OR 1.45 (95% CI: 1.25, 1.69) 3 month-poor functional outcome: OR 1.31 (95% CI: 1.15, 1.46) |
| Masrur et al. (31) | Retrospective analysis using GWTG-stroke database | USA | Patients with acute ischemic stroke; Median age of 72 years and 50% females | 72,909 subjects | HbA1c categorized as ≤ 6.5% and >6.5% | Symptomatic intracerebral hemorrhage (within 24h): OR 1.25 (95% CI: 1.07, 1.46) In hospital-mortality: OR 1.36 (95% CI: 1.21, 1.53) Poor functional outcome at discharge: OR 1.29 (95% CI: 1.19, 1.39) |
| Gao et al. (32) | Retrospective review of data from hospital-based registry | China | Patients with acute ischemic stroke; mean age of 62 years and 70% males | 793 subjects | HbA1c categorized as <5.9%; 5.9–6.7% and ≥6.7% | 3-month poor functional outcome HbA1c 5.9–6.7%: OR 1.63 (95% CI: 0.89, 2.98) HbA1c ≥ 6.7%: OR 2.10 (95% CI: 1.16, 3.79) |
| Lei et al. (33) | Chengdu stroke registry with prospective follow-up | China | Patients with acute ischemic stroke; mean age of 65 years and 60% males | 1,877 subjects | HbA1c categorized as 4.7–6.7%; 6.8% to 8.2% and >8.2% | 3-month poor functional outcome HbA1c 6.8–8.2%: OR 1.22 (95% CI: 0.86, 1.55) HbA1c >8.2%: OR 1.43 (95% CI: 1.15, 2.39) 3-month mortality HbA1c 6.8–8.2%: OR 1.32 (95% CI: 0.63, 3.01) HbA1c >8.2%: OR 1.43 (95% CI: 1.01, 1.98) 12-month poor functional outcome HbA1c 6.8–8.2%: OR 1.02 (95% CI: 0.52, 1.69) HbA1c >8.2%: OR 1.17 (95% CI: 1.01, 1.83) 12-month mortality HbA1c 6.8–8.2%: OR 1.22 (95% CI: 0.59, 1.65) HbA1c >8.2%: OR 1.48 (95% CI: 1.03, 2.30) |