Association between hemoglobin A1c and acute ischemic stroke among patients with type-2 diabetes: a case-control study

At present, stroke is a major health burden and the leading cause of death and long-term disability in the elderly. Ischemic stroke is the most common stroke type in the Thai population. Causes of ischemic stroke are likely to be multifactorial. The purpose of this study was to determine the association between hemoglobin A1c (HbA1c) and acute ischemic stroke (AIS) among Thai patients with type-2 diabetes (PTDs). A hospital-based case-control study was conducted among PTDs attending the Bhuddasothorn hospital with 100 cases and 300 controls from 2013 to 2016. Cases were defined as PTDs who had an AIS and diagnosed by neurologists and computed tomography (CT) scan and controls were PTDs who did not have AIS. Cases and controls were matched by gender, age (± 5 years), residential area, and attending duration. Data were collected using a questionnaire comprising 2 parts: demographic characteristics and medical data. Conditional logistic regression was applied to estimate the effect of HbA1c on acute ischemic stroke among PTDs. Univariable conditional logistic regression showed risk factors for AIS among the PTDs comprised history of dyslipidemia, history of atrial fibrillation, diastolic blood pressure, systolic blood pressure, HbA1c, history of CVD, FPG, creatinine, and microvascular complications (p < 0.05). For multivariable conditional logistic regression, after controlling for potential confounders, it revealed a HbA1c of 8–8.9% and higher increased the risk of AIS by a factor of 7.9 and 10.9 times, respectively (OR = 7.9, 95%CI = 3.0–20.9; OR = 10.9, 95%CI = 4.3–27.9). Ongoing surveillance of HbA1c among PTDs should be conducted alongside knowledge sharing of glycemic control and stroke prevention as an essential measure to prevent developing AIS risk.