Study Links Hypoglycemic Events to Increased Stroke Risk in Diabetics, Highlights Need for Prevention

"We found that hypoglycemic events in diabetes patients significantly increase the risk of acute ischemic stroke, raising it more than threefold on the first day and potentially triggering a stroke within 30 days of the episode," the researchers reported.

Acute ischemic stroke, caused by a sudden blockage of blood flow to the brain, is a leading cause of disability and mortality worldwide. In individuals with diabetes, maintaining optimal blood glucose levels is already a challenge, and hypoglycemic episodes—marked by dangerously low blood sugar—add a layer of complexity to stroke prevention.

Stroke triggers are factors that can initiate a stroke within a specific timeframe and help predict its onset. Although hypoglycemia is recognized as a risk factor for cardiovascular events like acute ischemic stroke (AIS), limited evidence exists to confirm its role as a stroke trigger. In light of this, Supriya Makam, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.), and colleagues propose a potential link between hypoglycemic episodes and stroke occurrence in diabetic patients.

For this purpose, the researchers analyzed Medicare data from inpatient, outpatient, emergency department, and subacute nursing facility records spanning 2016 to 2019. They identified conditions using validated International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes.

A case-crossover study design was employed to examine whether a hypoglycemic event within progressively longer case periods—up to 30 days before the index AIS—was associated with the subsequent occurrence of AIS. Control periods of the same duration, exactly one year before the case period, were used for comparison.

The study revealed the following findings:

• A total of 237,667 index admissions with acute ischemic stroke and diabetes were recorded during the study period.
• The odds of AIS significantly increased after a hypoglycemic event.
• The risk of AIS was highest on the first day following a hypoglycemia encounter, with an odds ratio of 3.694.
• The risk gradually decreased as the case-control interval lengthened.
• The risk was lowest at a 30-day case-control interval but remained significant, with an odds ratio of 2.345.

"Further research is required to explore the relationship between the severity of hypoglycemia and the occurrence and intensity of strokes. If additional studies validate these findings, they underscore the critical need to prevent hypoglycemic episodes in patients with diabetes," the researchers concluded.

Reference:

Makam S, Stein LK, Dhamoon MS. Hypoglycemic Events May Trigger Acute Ischemic Stroke Within 30 Days in Those With Diabetes: A Case-Crossover Study. Stroke. 2024 Nov 22. doi: 10.1161/STROKEAHA.124.049178. Epub ahead of print. PMID: 39575566.