Boden-Albala Bernadette, Cammack Sam, Chong Ji, Wang Culing, Wright Clinton, Rundek Tatjana, Elkind Mitchell S V, Paik Myunghee C, Sacco Ralph L
Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Diabetes Care. 2008 Jun;31(6):1132-7. doi: 10.2337/dc07-0797. Epub 2008 Mar 13.
There is insufficient randomized trial data to support evidence-based recommendations for tight control of fasting blood glucose (FBG) among diabetic subjects in primary stroke prevention. We explored the relationship between FBG among diabetic subjects and risk of ischemic stroke in a multiethnic prospective cohort.
Medical and social data and FBG values were collected for 3,298 stroke-free community residents: mean age +/- SD was 69 +/-10 years; 63% were women, 21% were white, 24% were black, and 53% were Hispanic; and follow-up was 6.5 years. Baseline FBG levels were categorized: 1) elevated FBG: history of diabetes and FBG >or=126 mg/dl (7.0 mmol/l); 2) target FBG: history of diabetes and FBG <126 mg/dl (7.0 mmol/l); or 3) no diabetes/reference group. Cox models were used to calculate hazard ratios (HRs) and 95% CI for ischemic stroke and vascular events.
In the Northern Manhattan Study, 572 participants reported a history of diabetes and 59% (n = 338) had elevated FBG. Elevated FBG among diabetic subjects was associated with female sex (P < 0.04), Medicaid (P = 0.01), or no insurance (P = 0.03). We detected 190 ischemic strokes and 585 vascular events. Diabetic subjects with elevated FBG (HR 2.7 [95% CI 2.0-3.8]) were at increased risk of stroke, but those with target FBG levels (1.2 [0.7-2.1]) were not, even after adjustment. A similar relationship existed for vascular events: elevated FBG (2.0 [1.6-2.5]) and target FBG (1.3 [0.9-1.8].
This prospective cohort study provides evidence for the benefits of tighter glucose control for primary stroke prevention.
目前尚无足够的随机试验数据来支持针对糖尿病患者进行严格空腹血糖（FBG）控制以预防初次卒中的循证推荐。我们在一个多民族前瞻性队列中探讨了糖尿病患者的FBG与缺血性卒中风险之间的关系。
收集了3298名无卒中的社区居民的医疗和社会数据以及FBG值：平均年龄±标准差为69±10岁；63%为女性，21%为白人，24%为黑人，53%为西班牙裔；随访时间为6.5年。基线FBG水平分类如下：1）FBG升高：有糖尿病史且FBG≥126 mg/dl（7.0 mmol/l）；2）目标FBG：有糖尿病史且FBG<126 mg/dl（7.0 mmol/l）；或3）无糖尿病/参照组。使用Cox模型计算缺血性卒中和血管事件的风险比（HR）及95%置信区间（CI）。
在北曼哈顿研究中，572名参与者报告有糖尿病史，其中59%（n = 338）的FBG升高。糖尿病患者中FBG升高与女性（P < 0.04）、医疗补助（P = 0.01）或无保险（P = 0.03）相关。我们检测到190例缺血性卒中和585例血管事件。即使在进行调整后，FBG升高的糖尿病患者发生卒中的风险增加（HR 2.7 [95% CI 2.0 - 3.8]），而目标FBG水平的患者则未增加（1.2 [0.7 - 2.1]）。血管事件也存在类似关系：FBG升高（2.0 [1.6 - 2.5]）和目标FBG（1.3 [0.9 - 1.8]）。
这项前瞻性队列研究为严格血糖控制对初次卒中预防的益处提供了证据。
