Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
BMJ. 2012 Jun 7;344:e3564. doi: 10.1136/bmj.e3564.
To assess the association between pre-diabetes and risk of stroke, and to evaluate whether this relation varies by diagnostic criteria for pre-diabetes.
Systematic review and meta-analysis of prospective studies.
A search of Medline, Embase, and the Cochrane Library (1947 to 16 July 2011) was supplemented by manual searches of bibliographies of key retrieved articles and relevant reviews.
Prospective cohort studies that reported multivariate adjusted relative risks and corresponding 95% confidence intervals for stroke with respect to baseline pre-diabetes were included.
Two independent reviewers extracted data on pre-diabetes status at baseline, risk estimates of stroke, study quality, and methods used to assess pre-diabetes and stroke. Relative risks were pooled using random effects models when appropriate. Associations were tested in subgroups representing different characteristics of participants and studies. Publication bias was evaluated with funnel plots.
The search yielded 15 prospective cohort studies including 760,925 participants. In 8 studies analysing pre-diabetes defined as fasting glucose 100-125 mg/dL (5.6-6.9 mmol/L), the random effects summary estimate did not show an increased risk of stroke after adjustment for established cardiovascular risk factors (1.08, 95% confidence interval 0.94 to 1.23; P = 0.26). In 5 studies analysing pre-diabetes defined as fasting glucose 110-125 mg/dL (6.1-6.9 mmol/L), the random effects summary estimate showed an increased risk of stroke after adjustment for established cardiovascular risk factors (1.21, 1.02 to 1.44; P = 0.03). In 8 studies with information about impaired glucose tolerance or combined impaired glucose tolerance and impaired fasting glucose, the random effects summary estimate showed an increased risk of stroke after adjustment for established cardiovascular risk factors (1.26, 1.10 to 1.43; P < 0.001). When studies that might have enrolled patients with undiagnosed diabetes were excluded, only impaired glucose tolerance or a combination of impaired fasting glucose and impaired glucose tolerance independently raised the future risk of stroke (1.20, 1.07 to 1.35; P = 0.002).
Pre-diabetes, defined as impaired glucose tolerance or a combination of impaired fasting glucose and impaired glucose tolerance, may be associated with a higher future risk of stroke, but the relative risks are modest and may reflect underlying confounding.
评估前驱糖尿病与中风风险之间的关联，并评估这种关系是否因前驱糖尿病的诊断标准而有所不同。
对前瞻性研究进行系统综述和荟萃分析。
对 Medline、Embase 和 Cochrane 图书馆（1947 年至 2011 年 7 月 16 日）进行检索，同时辅以对检索到的关键文章的参考文献和相关综述的手工检索。
纳入了报告基线时前驱糖尿病与中风的多变量调整相对风险以及相应 95%置信区间的前瞻性队列研究。
两名独立的审查员提取了基线时前驱糖尿病状态、中风风险估计、研究质量以及用于评估前驱糖尿病和中风的方法的数据。在适当的情况下，使用随机效应模型对相对风险进行了汇总。在代表参与者和研究不同特征的亚组中检验了相关性。使用漏斗图评估发表偏倚。
搜索结果得到 15 项前瞻性队列研究，包括 760925 名参与者。在 8 项分析空腹血糖 100-125mg/dL（5.6-6.9mmol/L）定义为前驱糖尿病的研究中，经过调整已确立的心血管风险因素后，随机效应汇总估计值并未显示中风风险增加（1.08，95%置信区间 0.94 至 1.23；P=0.26）。在 5 项分析空腹血糖 110-125mg/dL（6.1-6.9mmol/L）定义为前驱糖尿病的研究中，经过调整已确立的心血管风险因素后，随机效应汇总估计值显示中风风险增加（1.21，1.02 至 1.44；P=0.03）。在 8 项有关于糖耐量受损或糖耐量受损和空腹血糖受损联合的信息的研究中，经过调整已确立的心血管风险因素后，随机效应汇总估计值显示中风风险增加（1.26，1.10 至 1.43；P<0.001）。当排除可能纳入未确诊糖尿病患者的研究后，只有糖耐量受损或空腹血糖受损和糖耐量受损联合独立地增加了未来中风的风险（1.20，1.07 至 1.35；P=0.002）。
前驱糖尿病，定义为糖耐量受损或空腹血糖受损和糖耐量受损联合，可能与更高的未来中风风险相关，但相对风险较小，可能反映了潜在的混杂因素。
