scholarly journals Homeostasis model assessment of insulin resistance and outcome of ischemic stroke in non-diabetic patients - a prospective observational study

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Daniel Åberg ◽  
N. David Åberg ◽  
Katarina Jood ◽  
Lukas Holmegaard ◽  
Petra Redfors ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Ischemic Stroke ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Diabetic Patients ◽  
Model Assessment ◽  
Homeostasis Model Assessment

Insulin resistance may affect the functional recovery of acute ischemic stroke in non-diabetic patients

2020 ◽  
Author(s):  
Yoonkyung Chang ◽  
Chi Kyung Kim ◽  
Min-Kyung Kim ◽  
Woo‐Keun Seo ◽  
Kyungmi Oh
Keyword(s):  
Insulin Resistance ◽  
Logistic Regression ◽  
Ischemic Stroke ◽  
Blood Glucose ◽  
Acute Ischemic Stroke ◽  
Functional Recovery ◽  
Diabetic Patients ◽  
Model Assessment ◽  
Multivariate Logistic Regression ◽  
Stroke Patients

Abstract Background Insulin resistance is associated with the occurrence of stroke and atherosclerotic disease. However, the relationship between insulin resistance and the prognosis of acute ischemic stroke in nondiabetic patients is unclear. We hypothesized that insulin resistance may affect short-term functional recovery after acute ischemic stroke in nondiabetic patients. Methods Between May 2014 and December 2016, 1377 consecutive patients with acute ischemic stroke were enrolled from a prospectively maintained stroke registry. After excluding patients with transient ischemic attacks (TIA), pre-stroke disabilities, diabetes mellitus, and patients with incomplete evaluations, 517 patients were included in the study. The homeostasis model assessment of insulin resistance (HOMA-IR) score was used to evaluate the degree of insulin resistance. The factors associated with poor functional outcomes were analyzed using multivariate logistic regression. Results The patients with the highest quartile of log HOMA-IR index scores were younger and had higher fasting blood glucose, total cholesterol, triglycerides, low-density lipoprotein, and HbA1c levels. Multivariate logistic regression analysis revealed that log HOMA-IR scores were independently associated with poor prognosis after adjusting for age and sex and p < 0.1 in univariate analysis. Conclusion Insulin resistance measured by the HOMA-IR index was associated with the poor functional outcome of non-diabetic stroke patients. This evidence supports treating insulin resistance in acute ischemic stroke patients with blood glucose levels within the normal range.

scholarly journals Insulin resistance is associated with poor functional outcome after acute ischemic stroke in non-diabetic patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoonkyung Chang ◽  
Chi Kyung Kim ◽  
Min-Kyung Kim ◽  
Woo‐Keun Seo ◽  
Kyungmi Oh
Keyword(s):  
Insulin Resistance ◽  
Ischemic Stroke ◽  
Blood Glucose ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Fasting Blood Glucose ◽  
Diabetic Patients ◽  
Model Assessment ◽  
Stroke Patients ◽  
Poor Functional Outcome

AbstractInsulin resistance is associated with the occurrence of stroke and atherosclerotic disease. However, the relationship between insulin resistance and the prognosis of acute ischemic stroke in non-diabetic patients is unclear. We hypothesized that insulin resistance might affect short-term functional recovery after acute ischemic stroke in non-diabetic patients. Between May 2014 and December 2016, 1377 consecutive patients with acute ischemic stroke were enrolled from a prospectively maintained stroke registry. After excluding patients with transient ischemic attacks (TIA), pre-stroke disabilities, diabetes mellitus, and patients with incomplete evaluations, 517 patients were included in the study. The homeostasis model assessment of insulin resistance (HOMA-IR) score was used to evaluate the degree of insulin resistance. The patients with the highest quartile of log HOMA-IR index scores were younger and had higher fasting blood glucose, total cholesterol, triglycerides, low-density lipoprotein, and HbA1c levels. Multivariable logistic regression analysis revealed that log HOMA-IR scores were independently associated with poor prognosis after adjusting for age and sex and p < 0.1 in univariable analysis. Insulin resistance was associated with the poor functional outcome of non-diabetic stroke patients. This evidence supports treating insulin resistance in acute ischemic stroke patients with blood glucose levels within the normal range.

scholarly journals Homeostasis model assessment of insulin resistance in relation to the poor functional outcomes in nondiabetic patients with ischemic stroke

2018 ◽  
Vol 38 (3) ◽  
Author(s):  
Siou Li ◽  
Changhao Yin ◽  
Weina Zhao ◽  
Haifu Zhu ◽  
Dan Xu ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Ischemic Stroke ◽  
Insulin Sensitivity ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Model Assessment ◽  
Homeostasis Model Assessment ◽  
Poor Functional Outcome ◽  
Adjusted Risk ◽  
Poor Outcome

Whether insulin resistance (IR) predicts worse functional outcome in ischemic stroke is still a matter of debate. The aim of the present study is to determine the association between IR and risk of poor outcome in 173 Chinese nondiabetic patients with acute ischemic stroke. This is a prospective, population-based cohort study. Insulin sensitivity, expressed by the homeostasis model assessment (HOMA) of insulin sensitivity (HOMA index = (fasting insulin × fasting glucose)/22.5). IR was defined by HOMA-IR index in the top quartile (Q4). Functional impairment was evaluated at discharge using the modified Rankin scale (mRS). The median (interquartile range) HOMA-IR was 2.14 (1.17–2.83), and Q4 was at least 2.83. There was a significantly positive correlation between HOMA-IR and National Institutes of Health Stroke Scale (r = 0.408; P<0.001). In multivariate analyses, patients in IR group were associated with a higher risk of poor functional outcome (odds ratio (OR) = 3.23; 95% confidence interval (CI) = 1.75–5.08; P=0.001). In multivariate models comparing the third and fourth quartiles against the first quartile of the HOMA-IR, levels of HOMA-IR were associated with poor outcome, and the adjusted risk of poor outcome increased by 207% (OR = 3.05 (95% CI 1.70–4.89), P=0.006) and 429% (5.29 (3.05–9.80), P<0.001). In a receiver operating characteristic curve (ROC) analysis of poor outcome, the area under the curve (AUC) increased from 0.80 to 0.84 (95% CI: 0.79–0.88) by adding HOMA-IR to clinical examination variables (P=0.02). High HOMA-IR index is associated with a poor functional outcome in nondiabetic patients with acute ischemic stroke.

Predictive Value of Insulin Resistance as Determined by Homeostasis Model Assessment in Acute Ischemic Stroke Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 53 (11) ◽  
pp. 746-751
Author(s):  
An Wu ◽  
Yunping Li ◽  
Rongcai Liu ◽  
Dongjing Qi ◽  
Guofeng Yu ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Ischemic Stroke ◽  
Functional Outcome ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Stroke Recurrence ◽  
Model Assessment ◽  
Homeostasis Model Assessment ◽  
Poor Functional Outcome ◽  
All Cause Mortality

AbstractStudies on association between homeostasis model assessment of insulin resistance (HOMA-IR) and adverse outcomes have yielded conflicting results in patients with acute ischemic stroke (AIS). This meta-analysis aimed to assess the predictive value of HOMA-IR in AIS patients. Two authors comprehensively searched PubMed and Embase databases until February 28, 2021. All observational studies investigating the association between HOMA-IR and adverse outcomes in AIS patients were included. Outcome measures were poor functional outcome (Modified Rankin Scale≥3), all-cause mortality, stroke recurrence, and neurologic worsening. Seven studies (eight articles) involving 8330 AIS patients were identified. For the highest versus lowest HOMA-IR, the pooled risk ratio (RR) of poor functional outcome was 2.55 (95% CI 1.76–3.70) after adjustment of conventional confounding factors. In addition, elevated HOMA-IR was associated with higher risk of neurologic worsening (RR 1.93; 95% CI 1.15–3.26). However, there were conflicting findings on the association of HOMA-IR with stroke recurrence and all-cause mortality. This meta-analysis confirms that HOMA-IR is significantly associated with an increased risk of poor functional outcome in patients with AIS. However, interpretation of the results of mortality, stroke recurrence, and neurologic worsening should be done with caution due to small number of studies available.

Adipose proinflammatory cytokine expression through sympathetic system is associated with hyperglycemia and insulin resistance in a rat ischemic stroke model

2011 ◽  
Vol 300 (1) ◽  
pp. E155-E163 ◽  
Author(s):  
Ya-Yu Wang ◽  
Shih-Yi Lin ◽  
Yu-Han Chuang ◽  
Chun-Jung Chen ◽  
Kwong-Chung Tung ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Adipose Tissue ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Proinflammatory Cytokines ◽  
Model Assessment ◽  
Homeostasis Model Assessment ◽  
Protein Levels ◽  
Tnf Α ◽  
Cerebral Ischemic

Patients who experience acute ischemic stroke may develop hyperglycemia, even in the absence of diabetes, but the exact mechanisms are still unclear. Adipose tissue secretes numerous proinflammatory cytokines and is involved in the regulation of glucose metabolism. This study aimed to determine the effects of acute stroke on adipose inflammatory cytokine expression. In addition, because sympathetic activity is activated after acute stroke and catecholamines can regulate the expression of several adipocytokines, this study also evaluated whether alterations in adipose proinflammatory cytokines following acute stroke, if any, were medicated by sympathetic system. Acute ischemic brain injury was induced by ligating the right middle cerebral artery and bilateral common carotid arteries in male adult Sprague-Dawley rats. Adipose tumor necrosis factor-α (TNF-α) and monocyte chemoattractant protein-1 (MCP-1) mRNA and protein levels were determined by RT-PCR and enzyme-linked immunoassay, respectively. The stroke rats developed glucose intolerance on days 1 and 2 after cerebral ischemic injury. The fasting blood insulin levels and insulin resistance index measured by homeostasis model assessment were higher in the stroke rats compared with the sham group. Epididymal adipose TNF-α and MCP-1 mRNA and protein levels were elevated one- to twofold, in association with increased macrophage infiltration into the adipose tissue. When the rats were treated with a nonselective β-adrenergic receptor blocker, propranolol, before induction of cerebral ischemic injury, the acute stroke-induced increase in TNF-α and MCP-1 was blocked, and fasting blood insulin concentration and homeostasis model assessment-insulin resistance were decreased. These results suggest a potential role of adipose proinflammatory cytokines induced by the sympathetic nervous system in the pathogenesis of glucose metabolic disorder in rats with acute ischemic stroke.

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