Diabetes mellitus and glucose intolerance

Evidence

Risk factors for stroke

Diabetes mellitus and glucose intolerance are important risk factors for ischaemic stroke (Tuomilehto and Rastenye, 1999). Above a fasting blood glucose concentration of 4.9 mmol/l, there is a continuous association between fasting blood glucose levels and vascular disease; for every 1 mmol/l increase in fasting blood glucose there is a 21% (95% CI: 18–24%) increase in risk of stroke, 23% (95% CI: 19–27%) increase in risk of ischaemic heart disease events and 19% increase in cardiovascular deaths (Asia Pacific Cohort Studies Collaboration, 2004).

Effective strategies to reduce the risk of stroke in diabetics

Effective strategies to reduce the risk of stroke in diabetics include:

1. Preventing or delaying the onset of diabetes by appropriate lifestyle behaviours (to achieve target levels of risk factors) and perhaps use of the α-glucosidase inhibitor acarbose to improve insulin sensitivity (Chiasson et al., 2002, 2003).

2. Preventing atherogenesis by optimally controlling risk factors such as high blood pressure (Heart Outcomes Prevention Evaluation (HOPE) Study Investigators, 2000a,c), high blood cholesterol (Heart Protection Study Collaborative Group, 2003; Colhoun et al., 2004), high blood glucose (UK Prospective Diabetes Study (UKPDS) Group, 1998a,b) and smoking.

3. Preventing atherothrombosis, should an atherosclerotic plaque become eroded or rupture, with optimal antiplatelet therapy (Antithrombotic Trialists' Collaboration, 2002; Sacco et al., 2003).

4. Recanalising any accessible arteries which are stenosed and symptomatic by means of carotid endarterectomy (Rothwell et al., 2003).