L.B. NOVIKOVA, G.I. IZHBULDINA

Bashkir State Medical University, Ufa

 Contact details:

Novikova L.B. — MD, Professor, Head of the Neurology and Neurosurgery Department

Address: 3 Lenin St., Russian Federation, Ufa, 450008, tel.: +7-927-346-49-73, e-mail: novicova@inbox.ru

Among the reasons that increase the risk of stroke, its severity and outcome, a special place is given to disorders of carbohydrate metabolism. However, to date, there is no consensus on the role of hyperglycemia in stroke, whether it is physiological or pathological.

The purpose to study the effect of insulin resistance on the course and clinical outcome of ischemic stroke (IS) in the acute period.

Material and methods. A total of 862 patients with IS (370 men, 492 women), mean age was 66,1 ± 10,8 years. The degree of neurological deficit (NIHSS scale) and clinical outcome were assessed. When admitted to hospital, the level of glycemia, insulin, and C-peptide in the fasting blood were found.

Results. In 186 (21,6%) patients type 2 diabetes mellitus (DM) was diagnosed. In 27,8% of patients without DM and 76,3% of patients with DM hyperglycemia was detected. In patients without DM with hyperglycemia, compared with patients with normoglycemia, a higher representation of severe neurological deficit (by 14,7%), a lower frequency of noticeable positive dynamics (by 14,8%), and a higher mortality rate (by 11,5%) were found. In patients with DM, hyperglycemia was associated with a lower incidence of noticeable positive dynamics (by 27,7%). The development of IS is accompanied by an increase in the blood level of C-peptide more than twice. High values of the C-peptide/insulin ratio are associated with a higher frequency of severe neurological deficit in patients with DM (by 32,4%) and without DM (by 23,8%), and a decrease in the incidence of noticeable positive dynamics (by 23,5% and 20,9%, respectively).

Conclusion. Development of IS is characterized by high representation of disorders of carbohydrate metabolism. The severity of glucose metabolism disorders is interrelated with the severity and clinical outcome of the disease.

Key words: ischemic stroke, stress hyperglycemia, insulin resistance, C-peptide, type 2 diabetes.

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