Study of insulin resistance as an inflammatory marker for ischemic stroke severity among non-diabetics

Mohammed M. Nawaz; Harsha Sundaramurthy; Nemichandra S. C.; Shasthara Paneyala

doi:10.18203/2320-6012.ijrms20231634

Authors

Mohammed M. Nawaz Department of Neurology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
Harsha Sundaramurthy Department of Neurology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
Nemichandra S. C. Department of Neurology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
Shasthara Paneyala Department of Neurology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20231634

Keywords:

HOMA-IR, Insulin resistance, Ischemic stroke, NIHSS, Non-diabetic

Abstract

Background: Insulin resistance (IR) is emerging as an important modifiable risk factor causing acute ischemic stroke. The purpose of the study was to evaluate insulin resistance among patients of acute ischemic stroke, in non-diabetic patients, and to correlate insulin resistance with the severity of acute ischemic stroke, and to observe its association with traditional risk factors.

Methods: It was a prospective study conducted at JSS Medical College, Mysore, India from September 2021 to December 2022. Patients who presented with the history of stroke, who were non-diabetics and aged >18 years were included with informed consent. Ischemic stroke was diagnosed with clinical findings and by neuroimaging. Stroke severity was assessed by NIHSS score. Homeostasis model assessment (HOMA) was used to estimate insulin resistance and the levels were studied in relation to the stroke severity.

Results: A total of 127 non-diabetic ischemic stroke patients were enrolled in the study. Hyperinsulinemia, i.e. serum insulin >9 μU/mL, was observed in 44 (34.64%) patients. IR with HOMA-IR ≥2.5 was noted in 39 (30.7%) patients. NIHSS score in severity (group III) was strongly associated with serum insulin >9 μU/mL (62.1%) (P = 0.001) and HOMA-IR ≥2.5 (62.1%) (P<0.0001).

Conclusions: Screening for insulin resistance in nondiabetic patients with ischemic stroke may identify those who are at higher risk for poor outcomes, allowing for early intervention and closer monitoring. Also, interventions to reduce insulin resistance, such as lifestyle modifications or medications, may be beneficial in improving stroke outcomes.

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References

Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. 2007;6(2):182-187.

Folsom AR, Rasmussen ML, Chambless LE, Howard G, Cooper LS, Schmidt MI, et al. Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Diabetes Care. 1999;22(7):1077-83.

Kurl S, Laukkanen JA, Niskanen L, Laaksonen D, Sivenius J, Nyyssonen K, et al. Metabolic syndrome and the risk of stroke in middle-aged men. Stroke. 2006;37(3):806-11.

Rundek T, Gardener H, Xu Q, Goldberg RB, Wright CB, Boden-Albala B, Disla N, et al. Insulin resistance and risk of ischemic stroke among nondiabetic individuals from the northern Manhattan study. Arch Neurol. 2010;67(10):1195-1200.

Li W, Ma D, Liu M, Liu H, Feng S, Hao Z, et al. Association between metabolic syndrome and risk of stroke: a meta-analysis of cohort studies. Cerebrovasc Dis. 2008;25(6):539-47.

Lee SH, Park SY, Choi CS. Insulin resistance: From mechanisms to therapeutic strategies. Diabetes Metab J. 2022;46(1):15-37.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: Insulin resistance and B-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28(7):412-9.

Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: Comparison with the euglycemic insulin clamp. Diabetes Care. 1999;22(9):1462-70.

Hong S, Han K, Park CY. The insulin resistance by triglyceride glucose index and risk for dementia: Population-based study. Alzheimers Res Ther 2021;13(1):9.

Radaelli T, Farrell KA, Huston-Presley L, Amini SB, Kirwan JP, McIntyre HD, et al. Estimates of insulin sensitivity using glucose and c-peptide from the hyperglycemia and adverse pregnancy outcome glucose tolerance test. Diabetes Care 2010;33(3):490-4.

Ribo M, Molina C, Montaner J, Rubiera M, Delgado-Mederos R, Arenillas JF, et al. Acute hyperglycemia state is associated with lower tPA-induced recanalization rates in stroke patients. Stroke. 2005;36(8):1705-9.

Zhao Y, Li J, Li J, Wu L, Wang Y, Li K, et al. Insulin resistance is associated with severe lucid interval in patients with acute ischemic stroke. J Str Cerebrovas Dis. 2014;23(9):2389-95.

Cai Y, Xu MJ, Teng JF, Xu LJ, Zheng H, Chen L. et al. Insulin resistance predicts poor functional outcome after acute ischemic stroke in non-diabetic patients with minor stroke or transient ischemic attack. Frontiers in Neurol. 2019;10:182.

Zhang L, Li J, Li R, Li L, Liang X, Sun Z. et al. Association between insulin resistance and inflammatory response in acute ischemic stroke patients. Med. 2017;96(15):e654.

Park JH, Chung JW, Lee MJ, Ahn MJ, Kim N. Association of insulin resistance with severity of acute cerebral infarction in nondiabetic patients. Korean J Radiol. 2013;14(6):978-85.

Kernan WN, Viscoli CM, Furie KL, Young LH, Inzucchi SE, Gorman M, et al. Pioglitazone after ischemic stroke or transient ischemic attack. N Engl J Med. 2016;374:1321-31.

Rundek T, Gardener H, Xu Q, Goldberg RB, Wright CB, Boden-Albala B, Disla N, et al. Insulin resistance and risk of ischemic stroke among nondiabetic individuals from the northern Manhattan study. Arch Neurol. 2010;67(10):1195-1200.

Nakamura K, Sakurai M, Miura K, Morikawa Y, Ishizaki M, Yoshita K, et al. Homeostasis model assessment of insulin resistance and the risk of cardiovascular events in middle-aged non-diabetic Japanese men. Diabetologia. 2010;53(9):1894-1902.

Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Meigs JB, Bonadonna RC, et al. Insulin resistance as estimated by homeostasis model assessment predicts incident symptomatic cardiovascular disease in caucasian subjects from the general population: the Bruneck study. Diabetes Care. 2007;30(2):318-324.

Yang X, Li C, Li J, Hou D, Luo Y, Zhang S, et al. Insulin resistance is significantly related with worse clinical outcomes in non-diabetic acute ischemic stroke patients treated with intravenous thrombolysis. J Stroke Cerebrovas Dis. 2021;30(3):105526.

Olijhoek JK, van der Graaf Y, Banga JD, Algra A, Rabelink TJ, Visseren FL. The metabolic syndrome is associated with advanced vascular damage in patients with coronary heart disease, stroke, peripheral arterial disease or abdominal aortic aneurysm. Eur Heart J. 2004;25(4):342-8.

Ago T, Matsuo R, Hata J, Wakisaka Y, Kuroda J, Kitazono T, et al. Insulin resistance and clinical outcomes after acute ischemic stroke. Neurol. 2018;90(17):e1470-7.

Wang L, Li H, Li Y, Li X, Li Y, Li M, et al. Insulin Resistance is associated with poor outcomes in non-diabetic patients with acute ischemic stroke. Frontiers in Neurol. 2022;13:831.

Wieberdink RG, Koudstaal PJ, Hofman A, Witteman JC, Breteler MM, Ikram MA. Insulin resistance and the risk of stroke and stroke subtypes in the nondiabetic elderly. Am J Epidemiol. 2012;176(8):699-707.