Epidemiology and Risk Factors
People with DM have with a two- to tenfold risk of stroke [5,9,10] Pre-diabetes is also linked with an increased risk of stroke [13] Comorbidities, such as hypertension, dyslipidaemia, previous MI and heart failure, increase the risk of stroke [31,32,33,34] Microvascular diabetic complications are associated with an increased risk of stroke, as well [43,44]
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Clinical manifestations
Ischaemic and haemmorrhagic stroke [45] DM is associated with commoner posterior circulation brain infarction and brain stem infarction [46] DM subjects had lower cortical thickness and creatine bilaterally in the sensorimotor cortex [47]
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Pathophysiology
Systemic inflammation is important in the development of atherosclerotic plaques [9] Reduced endothelial NO production causes endothelial dysfunction and atherosclerotic changes [4,55,56] Activation of nuclear factor NF-kB promotes the transcription of pro-atherogenic and pro-inflammatory factors [53,55,56] Hyperglycaemia activates the polyol pathway, increases formation of AGEs and RAGE, thus promoting atherosclerosis [53,55]
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Management of hyperglycaemia during acute stroke
Suggested levels of blood glucose are between 140–180mg/dl (7.8–10 mmol/L) [59] Intensive glucose control in the acute phase is controversial [61,62,63,64,65]
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Prevention
Some GLP-1RAs, including dulaglutide, liraglutide and semaglutide, offer protection against stroke according to cardioprotection studies [66,67,68,69,70,71,72,73,74,75] Rivaroxaban can be used as an alternative to warfarin for stroke prevention [82] Physical activity and weight reduction are advisable for secondary prevention [83,84] Meticulous management of hyperglycaemia and hypertension can reduce stroke incidence [89,90,91,92,93,94,95,96,97,98]
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Emerging BiomarkersSeveral biomarkers have been examined for the prediction of stroke, but none of them have been unequivocally confirmed as reliable and useful [43,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124]
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