Differential associations between pre-diabetes, diabetes and stroke occurrence among West Africans

Authors

• Fred Stephen Sarfo, Kwame Nkrumah University of Science & Technology
• Bruce Ovbiagele, University of California, San Francisco
• Joshua Akinyemi, College of Medicine, University of Ibadan
• Onoja Akpa, College of Medicine, University of Ibadan
• Albert Akpalu, University of Ghana
• Kolawole Wahab, University of Ilorin
• Godwin Ogbole, College of Medicine, University of Ibadan
• Reginald Obiako, Ahmadu Bello University
• Morenikeji Komolafe, Obafemi Awolowo University
• Lukman Owolabi, Aminu Kano Teaching Hospital
• Godwin Osaigbovo, Delta State University Teaching Hospital
• Carolyn Jenkins, Medical University of South Carolina
• Adekunle Fakunle, College of Medicine, University of Ibadan
• Abiodun Adeoye, College of Medicine, University of Ibadan
• Dan Lackland, Medical University of South Carolina
• Donna Arnett, University of Kentucky
• Hemant K. Tiwari, The University of Alabama at Birmingham
• Taiwo Olunuga, Federal Medical Centre Nigeria
• Ezinne Uvere, College of Medicine, University of Ibadan
• Bimbo Fawale, Obafemi Awolowo University
• Okechukwu Ogah, College of Medicine, University of Ibadan
• Atinuke Agunloye, College of Medicine, University of Ibadan
• Moyinoluwalogo Faniyan, College of Medicine, University of Ibadan
• Samuel Diala, College of Medicine, University of Ibadan
• Oladele Yinka, College of Medicine, University of Ibadan
• Ruth Laryea, University of Ghana
• Adeleye Osimhiarherhuo, Federal Medical Centre Nigeria
• Cynthia Akinsanya, Federal Medical Centre Nigeria

Abstract

Background: There are limited data from Africa on the burden and associations between pre-diabetes (pre-DM), diabetes mellitus (DM) and stroke occurrence in a region experiencing a profound rise in stroke burden. Purpose: To characterize the associations between stroke and dysglycemic status among West Africans. Methods: The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with clinical and radiological evidence of an acute stroke. Controls were age-and-gender matched stroke-free adults. Detailed evaluations for vascular factors were performed. Pre-diabetes was defined as HBA1c of 5.7%-6.4% or Fasting blood glucose (FBG) 5.6-7.0 mmol/L and DM as HBA1c >6.5% or FBG>7.0 mmol/L. We used conditional logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval. Results: Among 2,935 stroke cases the mean age was 60.0 ± 14.2 years with 55.2% being males. By glycemic status, 931 (31.7%) were euglycemic, 633 (21.6%) had Pre-diabetes and 1371 (46.7%) had DM. Of the age- and sex-matched stroke-free controls 69.2% were euglycemic, 13.3% had pre-DM and 17.5% had DM. Pre-DM [aOR (95% CI): 3.68(2.61-5.21)] and DM [4.29 (3.19-5.74)] were independently associated with stroke. The aOR of Pre-DM for ischemic stroke 3.06 (2.01–4.64)] was lower than 4.82 (3.37-6.89) for DM. However, the aOR of Pre-DM for hemorrhagic stroke 6.81 (95% CI: 3.29 – 14.08)] was higher than 3.36 (1.94–5.86) for DM. Furthermore, the aOR of pre-DM for ischemic stroke subtypes were 9.64 (1.30-71.57) for cardio-embolic stroke, 3.64 (1.80–7.34) for small-vessel occlusive disease and 4.63 (0.80-26.65) for large-vessel disease. Conclusion: Pre-DM is strongly and independently associated with stroke in Africans. Improving glycemic control through screening, healthy lifestyle and pharmacotherapy at a population level may be strategic in reducing the rising burden of stroke in Africa.

Publication Title

Journal of Stroke and Cerebrovascular Diseases

Recommended Citation

Sarfo, F., Ovbiagele, B., Akinyemi, J., Akpa, O., Akpalu, A., Wahab, K., Ogbole, G., Obiako, R., Komolafe, M., Owolabi, L., Osaigbovo, G., Jenkins, C., Fakunle, A., Adeoye, A., Lackland, D., Arnett, D., Tiwari, H., Olunuga, T., Uvere, E., Fawale, B., Ogah, O., Agunloye, A., Faniyan, M., Diala, S., Yinka, O., Laryea, R., Osimhiarherhuo, A., & Akinsanya, C. (2022). Differential associations between pre-diabetes, diabetes and stroke occurrence among West Africans. Journal of Stroke and Cerebrovascular Diseases, 31 (11) https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106805