Diabetes mellitus and cerebrovascular diseases

Authors: Zuzana Gdovinová
Authors‘ workplace: Neurologická klinika, LF UPJŠ a UN LP, Košice
Published in: Forum Diab 2017; 6(3): 115-120
Category: Topic


Diabetes mellitus is a serious risk factor for stroke and dementia. As acute hyperglycemia in stroke is associated with poor functional recovery and increased mortality, its proper management is critical for improving outcomes. Hypoglycemia is also an unfavorable prognostic factor, therefore, it is advisable to avoid a blood glucose lower than 100 mg/dL (5.6 mmol/L). Prevention of the development of dementia is the treatment of other risk factors, in particular hypertension and dyslipidemia.

Key words:
brain hemorrhage, dementia, diabetes mellitus, intravenous thrombolysis, stroke, thrombectomy


1. Heidenreich PA, Trogdon JG, Khavjou OA et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011; 123(8): 933–944. Dostupné z DOI: <http://dx.doi.org/10.1161/CIR.0b013e31820a55f5>.

2. Putaala J, Liebkind R, Gordin D et al. Diabetes mellitus and ischemic stroke in the young: clinical features and long-term prognosis. Neurology 2011; 76(21): 1831–1837. Dostupné z DOI: <http://dx.doi.org/10.1212/WNL.0b013e31821cccc2>.

3. Quinn TJ, Dawson J, Walters MR. Sugar and stroke: Cerebrovascular disease and blood glucose control. Cardiovasc Ther 2011; 29(6): e31-e42. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1755–5922.2010.00166.x>.

4. Sarwar N, Gao P, Seshasai SR et al. [Emerging Risk Factors Collaboration]. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375(9733): 2215–2222. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(10)60484–9>. Erratum in Lancet 2010; 376(9745): 958.

5. Vaidya V, Gangan N, Sheehan J. Impact of cardiovascular complications among patients with Type 2 diabetes mellitus: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2015; 15(3): 487–497. Dostupné z DOI: <http://dx.doi.org/10.1586/14737167.2015.1024661>.

6. Chen R, Ovblagele B, Feng W. Diabetes and stroke: Epidemiology, Pathophysiology, Pharmaceuticals and Outcomes. Am J Med Sci 2016; 351(4): 380–386. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjms.2016.01.011>.

7. Weir CJ, Murray GD, Dyker AG et al. Is hyperglykemia an independent predicotr of poor outcome after acute stroke? Results og long-term follow up study. BMJ 1997; 314(7090): 1303–1306.

8. Gray CS, Hildreth AJ, Sandercock PA et al. Glucose-potassium-insulin infusions in the management in post-stroke hyperglycaemia: the UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurol 2007; 6(5): 397–406.

9. Ntaios G, Papavasileiou V, Bargiota A et al. Intravenous insulin treatment in acute stroke: a systematic review and meta-analysis of randomized controlled trials. Int J Stroke 2014; 9(4): 489–493. Dostupné z DOI: <http://dx.doi.org/10.1111/ijs.12225>.

10. Jauch EC, Saver JL, Adams HP et al. Guideline for the early management of úatients wirh acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44(3): 870–947. Dostupné z DOI: <http://dx.doi.org/10.1161/STR.0b013e318284056a>.

11. Derex L, Nighoghossian N. Intracerebral haemorrhage after thrombolysis for acute ischemic stroke: an uptade. J Neurol Neurosurg Psychiatry 2008; 79(10):1093–1099. Dostupné z DOI: <http://dx.doi.org/10.1136/jnnp.2007.133371>.

12. De Keyser J, Gdovinová Z, Uyttenboogaart M et al. Intravenous alteplase for stroke: beyond the guidelines and in particular situations. Stroke 2007; 38(9): 2612–2618.

13. Saqqur M, Shuaib A, Alexandrov AV et al. The correlation between admission blood glucose and intravenous rt-PA induced arterial recanalization in acute ischemic stroke: a multi-centre TCD study. Int J Stroke 2015;10(7): 1087–1092. Dostupné z DOI: <http://dx.doi.org/10.1111/ijs.12517>.

14. Mansfield MW, Heywood DM, Grant PJ. Sex differences in coagulation and fibrinolysis in white subjects with non-insulin dependent diabetes mellitus. Arterioscler Thromb Vasc Biol 1996; 16(1): 160–164.

15. Kent TA, Soukup VM, Fabian RH. Heterogenity affecting outcome form acute stroke therapy: making reperfusion worse. Stroke 2001; 32(10): 2318–2327.

16. Bellolio MF, Gilmore R, Ganti L. Insulin for glycaemic control in acute ischaemic stroke. Cochrane Database Syst Rev 2014; 23(1): CD005346. Dostupné z DOI: <http://dx.doi.org/10.1002/14651858.CD005346.pub4>.

17. [European Stroke Organisation (ESO) Executive Committee]. [ESO Writing Committee]. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008; 25(5): 457–507. Dostupné z DOI: <http://dx.doi.org/10.1159/000131083>.

18. Miedema I, Luijckx G.J, Brouns R et al. Admission hyperglycemia and outcome after intravenous thrombolysis: is there a difference among the stroke-subtypes? BMC Neurol 2016; 16: 104. Dostupné z DOI: <http://dx.doi.org/10.1186/s12883–016–0617–0>.

19. Osei E, den Hertog HM, Berkhemer OA et al. Admission glucose and effect on intra-arterial treatment in patients with acute ischemic stroke. Stroke 2017; 48(5): 1299–1305. Dostupné z DOI: <http://dx.doi.org/10.1161/STROKEAHA.116.016071>.

20. Tun NN, Arunagirinathan G, Munshi SK et al. Diabetes mellitus and stroke: A clinical update. World J Diabetes 2017; 8(6): 235–248. Dostupné z DOI: <http://dx.doi.org/10.4239/wjd.v8.i6.235>.

21. Go AS, Hylek EM, Borowsky LH et al. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. Ann Intern Med 1999; 131(12): 927–934.

22. Rhee SY. Hypoglycemia and dementia. Endocrinol Metab 2017; 32(2): 195–199. Dostupné z DOI: <http://dx.doi.org/10.3803/EnM.2017.32.2.195>.

23. Thacker EL, Psaty BM, McKnight B et al. Fasting and post-glucose load measures of insulin resistance and risk of ischemic stroke in loder adults. Stroke 2011; 42(12): 3347–3351. Dostupné z DOI: <http://dx.doi.org/10.1161/STROKEAHA.111.620773>.

24. Zinman B, Wanner C,Lachin JM et al. Empaglifozin, cardiovascular outcomes, and mortality in Type 2 diabetes. N Engl J Med 2015; 373(22): 2117–2128. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1504720>.

25. Cheng G, Huang C, Deng H et al. Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Intern Med J 2012; 42(5): 284–491. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1445–5994.2012.02758.x>.

26. Gudala K, Bansal D, Schifano F et al. Diabetes mellitus and risk of dementia: a meta-analysis of prospective observational studies. J Diabetes Investig 2013; 4(6): 640–650. Dostupné z DOI: <http://dx.doi.org/10.1111/jdi.12087>.

27. Cukierman T, Gerstein HC, Williamson JD et al. Cognitive decline and dementia – systematic overview of prospective observational studies. Diabetologia 2005; 48(12): 2460–2469.

28. Feinkohl I, Price JF, Stracha MW et al. The impact of diabetes on cognitive decline: Potential vascular metabolic and psychosocial risk factors. Alzheimer´s Res Therapy 2015; 7(1):46. Dostupné z DOI: <http://dx.doi.org/10.1186/s13195–015–0130–5>.

29. De Felice FG, Benedict C. A key role of insulin receptors in memory. Diabetes 2015; 64(11): 3653–3655. Dostupné z DOI: <http://dx.doi.org/10.2337/dbi15–0011>.

30. Van Duinkerken E, Schoonheim MM, Sanz-Arigita EJ et al. Resting-state brain networks in type 1 diabetic patients with and without microangiopathy and their relation to cognitive functions and disaes variables. Diabetes 2012; 61(7): 1814–1821. Dostupné z DOI: <http://dx.doi.org/10.2337/db11–1358>.

31. Kimura N. Diabetes mellitus induces Alzheimer´s disease pathology: histopathological evidence from animal modles. Int J Mol Sci 2016; 17(4): 503. Dostupné z DOI: <http://dx.doi.org/10.3390/ijms17040503>.

32. Su F, Shu H, Ye Q et al. Brain insulin resistance deteriorates cognition by altering the topological features of brain networks. Neuroimage Clin 2017; 13: 280–287. Dostupné z DOI: <http://dx.doi.org/10.1016/j.nicl.2016.12.009>.

33. Kullmann S, Heni M, Hallschmid M et al. Brain insulin resistance at the crossroads of metabolic and cognitive disorders in humans. Physiol Rev 2016; 96(4): 1169–1209. Dostupné z DOI: <http://dx.doi.org/10.1152/physrev.00032.2015>.

34. Neumann KF, Rojo L, Navarrete LP et al. Insulin resistance and Alzheimer´s disease: molecular links and clinical implications. Curr Alzheimer Res 2008; 5(5): 438–447.

35. Rudolph JD, de Graauw M, van de Water B et al. Elucidation of signaling pathways from large-scale phosphoproteomic data using protein interaction networks. Cell Syst 2016; 3(6): 585–593.e3. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cels.2016.11.005>.

36. Lutski M, Wienstein G, Goldbourt U et al. Insulin resistance and future cognitive performance and cognitive decline in elderly patients with cardiovascular disease. J Alzheimers Dis 2017; 57(2): 633–643. Dostupné z DOI: <http://dx.doi.org/10.3233/JAD-161016>.

37. Zhou H, Lu W, Shi Y et al. Impairments in cognition and resting-state connectivity of the hippocampus in elderly subjects with type 2 diabetes. Neurosci Lett 2010; 473(1): 5–10. Dostupné z DOI: <http://dx.doi.org/10.1016/j.neulet.2009.12.057>.

38. Zhang J, Liu Z, Li Z et al. Disrupted white mater network and cognitive decline in type 2 diabetes patients. J Alzheimers Dis 2016; 53(1): 185–195. Dostupné z DOI: <http://dx.doi.org/10.3233/JAD-160111>.

39. Launer LJ, Miller ME, Williamson JD et al. [ACCORD MIND investigators]. Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy. Lancet Neurol 2011; 10(11): 969–977. Dostupné z DOI: <http://dx.doi.org/10.1016/S1474–4422(11)70188–0>.

40. Sinclair AJ, Paolisso G, Castro M et al. European diabetes working party for older people. Clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab 2011; 37(Suppl 3): S27-S38. Dostupné z DOI: <http://dx.doi.org/10.1016/S1262–3636(11)70962–4>.

Diabetology Endocrinology Internal medicine
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account