Association of HbA1c Levels with Extent and Functional Status of Ischemic and Hemorrhagic Stroke

Document Type: Original Article


1 Associate Professor of Neurology, Department of Neurology, School of Medicine, Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

2 Assistant Professor of Pharmacology, Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

3 General Practitioner, Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

4 Instructor of Biostatistics, Department of Epidemiology and Biostatistics, Rafsanjan University of Medical Sciences, Rafsanjan, Iran


Background:HbA1c is an established diagnostic index which is used to assess diabetes mellitus. The aim of this study was to evaluate the association between HbA1c level with the types of stroke as well as the extent and functional status of ischemic stroke (IS) and hemorrhagic stroke (HS) in patients.
Methods: In this cross-sectional study, we evaluated 120 patients with IS and HS. The functional outcome was evaluated based on the MRS criteria. The extent of the lesion was determined according to CT scan and MRI. We measured the blood hemoglobin A1c (HbA1c) levels in all patients after stroke.
Results:HbA1c level in the IS group was significantly higher compared to the HS group
 (p < 0.05). There was a statistically significant difference between the extent of the lesion and the functional status of patients with the type of stroke (P < 0.001). History of smoking, in the IS group, was significantly associated with exposure to worse functional outcome (p<0.05). In the HS group, there was a significant relationship between hyperlipidemia histories with worse functional outcome. However, the relationship between HbA1c level and MRS score was inversely significant (p<0.05). Data analysis showed that, only in the IS group, the relationship between some independent variables, history of HLP and smoking, and the extent of stroke was significant (p<0.05).
Conclusion: Findings of this study showed that there was a significant association between HbA1clevels as well as the extent and functional status with the type of stroke. There was a significant inverse relationship between HbA1c levels with the MRS score.


  1. Go AS, Bauman M, King SMC, Fonarow GC, Lawrence W, Williams KA, et al. An effective approach to high blood pressure control. Hypertension. 2013:878-83.
  2. Mestriner RG, Saur L, Bagatini PB, Baptista PPA, Vaz SP, Ferreira K, et al. Astrocyte morphology after ischemic and hemorrhagic experimental stroke has no influence on the different recovery patterns. Behavioural brain research. 2015;278:257-61.
  3. Lieber BA, Taylor B, Appelboom G, Prasad K, Bruce S, Yang A, et al. Meta-analysis of telemonitoring to improve HbA1c levels: promise for stroke survivors. Journal of Clinical Neuroscience. 2015;22(5):807-11.
  4. Hägg S, Thorn LM, Forsblom CM, Gordin D, Saraheimo M, Tolonen N, et al. Different risk factor profiles for ischemic and hemorrhagic stroke in type 1 diabetes mellitus. Stroke. 2014:STROKEAHA. 114.005724.
  5. Chen Y-Y, Lin Y-J, Chong E, Chen P-C, Chao T-F, Chen S-A, et al. The impact of diabetes mellitus and corresponding HbA1c levels on the future risks of cardiovascular disease and mortality: a representative cohort study in Taiwan. PloS one. 2015;10(4):e0123116.
  6. Hewitt J, Castilla Guerra L, Fernández-Moreno MdC, Sierra C. Diabetes and stroke prevention: a review. Stroke research and treatment. 2012;2012.
  7. Roquer J, Rodríguez-Campello A, Cuadrado-Godia E, Giralt-Steinhauer E, Jiménez-Conde J, Soriano C, et al. The role of HbA1c determination in detecting unknown glucose disturbances in ischemic stroke. PloS one. 2014;9(12):e109960.
  8. Yang S, Zhao J, Chen Y, Lei M. Biomarkers associated with ischemic stroke in diabetes mellitus patients. Cardiovascular toxicology. 2016;16(3):213-22.
  9. Little RR, Rohlfing CL. The long and winding road to optimal HbA1c measurement. Clinica Chimica Acta. 2013;418:63-71.
  10. Choi JH, Yu KP, Yoon Y-S, Kim ES, Jeon JH. Relationship Between HbA1c and Complex Regional Pain Syndrome in Stroke Patients With Type 2 Diabetes Mellitus. Annals of rehabilitation medicine. 2016;40(5):779-85.
  11. Dave J, Engel M, Freercks R, Peter J, May W, Badri M, et al. Abnormal glucose metabolism in non-diabetic patients presenting with an acute stroke: prospective study and systematic review. QJM: An International Journal of Medicine. 2010;103(7):495-503.
  12. Huisa BN, Roy G, Kawano J, Schrader R. Glycosylated hemoglobin for diagnosis of prediabetes in acute ischemic stroke patients. Journal of Stroke and Cerebrovascular Diseases. 2013;22(8):e564-e7.
  13. Robson R, Lacey A, Luzio S, Van Woerden H, Heaven M, Wani M, et al. HbA1c measurement and relationship to incident stroke. Diabetic Medicine. 2016;33(4):459-62.
  14. Kerner W, Brückel J. Definition, classification and diagnosis of diabetes mellitus. Experimental and Clinical Endocrinology & Diabetes. 2014;122(07):384-6.
  15. Go AS, Bauman MA, King SMC, Fonarow GC, Lawrence W, Williams KA, et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Journal of the American College of Cardiology. 2014;63(12):1230-8.
  16. Park HJ, Leem AY, Lee SH, Song JH, Park MS, Kim YS, et al. Comorbidities in obstructive lung disease in Korea: data from the fourth and fifth Korean National Health and Nutrition Examination Survey. International journal of chronic obstructive pulmonary disease. 2015;10:1571.
  17. Singh JA, Houston TK, Ponce BA, Maddox G, Bishop MJ, Richman J, et al. Smoking as a risk factor for short‐term outcomes following primary total hip and total knee replacement in veterans. Arthritis care & research. 2011;63(10):1365-74.
  18. Mitsios JP, Ekinci EI, Mitsios GP, Churilov L, Thijs V. Relationship Between Glycated Hemoglobin and Stroke Risk: A Systematic Review and Meta‐Analysis. Journal of the American Heart Association. 2018;7(11):e007858.
  19. Giorda CB, Avogaro A, Maggini M, Lombardo F, Mannucci E, Turco S, et al. Incidence and risk factors for stroke in type 2 diabetic patients. Stroke. 2007;38(4):1154-60.
  20. Collaboration ERF. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. The Lancet. 2010;375(9733):2215-22.
  21. Bravata DM, Kim N, Concato J, Brass L. Hyperglycaemia in patients with acute ischaemic stroke: how often do we screen for undiagnosed diabetes? Qjm. 2003;96(7):491-7.
  22. Hesami O, Kasmaei HD, Matini F, Assarzadegan F, Mansouri B, Jabbehdari S. Relationship between intracerebral hemorrhage and diabetes mellitus: a case-control study. Journal of clinical and diagnostic research: JCDR. 2015;9(4):OC08.
  23. Roquer J, Rodríguez-Campello A, Gomis M, Jiménez-Conde J, Cuadrado-Godia E, Vivanco R, et al. Acute stroke unit care and early neurological deterioration in ischemic stroke. Journal of neurology. 2008;255(7):1012-7.
  24. Selvin E, Steffes MW, Gregg E, Brancati FL, Coresh J. Performance of A1C for the classification and prediction of diabetes. Diabetes care. 2011;34(1):84-9.
  25. Tavares RS, Souza FOd, Francescantonio ICCM, Soares WC, Mesquita MM. HbA1c levels in individuals heterozygous for hemoglobin variants. Revista da Associação Médica Brasileira. 2017;63(4):341-6.
  26. Wada S, Yoshimura S, Inoue M, Matsuki T, Arihiro S, Koga M, et al. Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring. Journal of the American Heart Association. 2018;7(8):e008744.
  27. Shafa MA, Ebrahimi H, Iranmanesh F, Sasaie M. Prognostic value of hemoglobin A1c in nondiabetic and diabetic patients with acute ischemic stroke. Iranian journal of neurology. 2016;15(4):209.
  28. Li H, Kang Z, Qiu W, Hu B, Wu A-m, Dai Y, et al. Hemoglobin A1C is independently associated with severity and prognosis of brainstem infarctions. Journal of the neurological sciences. 2012;317(1):87-91.
  29. Sunaga K, Miura K, Naruse Y, Sakurai M, Morikawa Y, Kurosawa Y, et al. Glycated hemoglobin and risk of stroke, ischemic and hemorrhagic, in Japanese men and women. Cerebrovascular Diseases. 2008;26(3):310-6.
  30. Chmielewska B, Hasiec T, Belniak-Legieć E, editors. The concentration of glucose, glycosylated hemoglobin and fructosamine in blood of patients with cerebral hemorrhage in the acute stage of the disease. Annales Universitatis Mariae Curie-Sklodowska Sectio D: Medicina. 1995; 50:123-130.
  31. Shuangxi G, Song T, Bo S, Avinash C, Anna M, Hui F, et al. Study of the relationship of glycated hemoglobin levels and neurological impairment and three months prognosis in patients with acute ischemic stroke. Life Sci J. 2012;9(2):119-21.
  32. Kamouchi M, Matsuki T, Hata J, Kuwashiro T, Ago T, Sambongi Y, et al. Prestroke glycemic control is associated with the functional outcome in acute ischemic stroke. Stroke. 2011;42(10):2788-94.
  33. Ibrahim M, Moussavi M, Korya D, Siddique U, Panezai S, Gizzi M, et al. Increased Hemoglobin A1c Level Is Associated with a Better Outcome in Patients with Spontaneous Intracerebral Hemorrhage (P02. 224). Neurology. 2012;78(1 Supplement):P02. 224-P02. .
  34. Mehta S, Dass P, Moussavi M, Sodhi R, Nizam A, Korya D, et al. Increased Hemoglobin A1c Level Is Associated with Decreased Hematoma Volume in Patients with Spontaneous Intracerebral Hemorrhage (P03. 176). Neurology. 2013;80(7 Supplement):P03. 176-P03. .
  35. Wolf PA, D'Agostino RB, Kannel WB, Bonita R, Belanger AJ. Cigarette smoking as a risk factor for stroke: the Framingham Study. Jama. 1988;259(7):1025-9.