Is there any agreed cut off point for serum HbA1c level to be considered as a protective burden for Ischemic Cerebrovascular Accidents occurrence in Diabetics?

Introduction Diabetes mellitus is one of the most common chronic diseases worldwide. It associated with a higher risk of cardiovascular complications, including cerebrovascular accidents. Studies show that people with diabetes have twice the risk of stroke compared to those without diabetes. The high rates of stroke-related morbidity result in a substantial economic burden. In patients with type 2 diabetes, maintaining HbA1c about 1 percentage point lower with intensive glucose control for several years leads to lasting clinical benefits. The current study aims to determine, despite the potential role of diabetes mellitus in cerebrovascular events (ischemic stroke), which HbA1c cut-off increased the risk of cerebrovascular events and which cut-off is safe in terms of cerebrovascular events. This study had been designed with a fucose on HBA1c cut-off point determination compatible with significant increased risk and incidence for ischemic cerebrovascular attacks in diabetes. Methods and Materials Diabetic patients of more than 18 years old who had clinical symptoms and signs of an acute ischemic stroke in recent 6 hours which have been confirmed subsequently by cranial neuroimaging of Computed Tomography Scan or Magnetic Resonance Imaging by an emergency medicine specialist or a neurologist, were included in the study, while diabetic patients with no history of stroke were considered the control group. Serum HbA1c level has been evaluated for both groups. Data has been analyzed to evaluate correlation of serum HbA1c level cut-off with risk of cerebrovascular ischemic stroke in diabetics. Sample size with a power of 80% was calculated 62 diabetic patients with acute ischemic stroke and 62 diabetic patients without stroke as control group. Results Demographic and baseline characteristics of both the case and control groups were compared. There were no significant differences between the two groups in age, sex, IHD, HTN, DLP, and smoking. We had 62 diabetic patients with CVA with a mean age of 64.16±12.43 and 62 diabetic patients without CVA with a mean age of 63.37±6.82. Regarding comparing the HbA1C average between patients with and without CVA, the mean in patients with CVA was 8.21 ±1.70, while in patients without CVA it was 7.56 ±1.28 that which was significantly higher in CVA (p-value <0.02). Using logistic regression, the odds ratio (OR) with a 95% confidence interval was calculated as 1.34 (1.05,1.71). The predictive value of HbA1c for an increase in the risk of CVA occurrence was determined by ROC curve plotting; an AUC with 95% CI (0.516,0.694) was calculated 0.608 (p-value<0.036). Youden index for optimal HbA1c range for CVA risk, considering sensitivity as 69.35 and specificity as 35.48; showed a HbA1c cut-off point of 6.8. Discussion Several studies have assessed differences in mean HbA1c levels between individuals with and without stroke, but the findings have been inconsistent. In addition, only a few studies have demonstrated the predictive value of HbA1c for stroke or identified the specific levels that put patients at higher risk. In this study, we show that the HbA1c mean in diabetic patients with stroke was significantly higher than diabetic patients without stroke. Having diabetes substantially increased the odds of ischemic stroke roughly in the range of 30%to 100% higher risk after adjusting for other vascular risk factors. In a trial, patients with HbA1c<6.8% experienced cardio protection, those with 6.8% to 8.7% showed neutral effects, while HbA1c>8.6% faced increased risk, indicating that lifestyle intervention’s vascular benefits including ischemic stroke prevention are limited to patients with relatively well controlled baseline glycemia. Our study shows that higher HbA1c levels are associated with a raised risk of stroke. Recognizing the HbA1c level that puts patients at higher risk of stroke can help clinicians focus on better glycemic control. Therefore, keeping HbA1c within safe ranges may play an important role in preventing strokes. Conclusion Elevated HbA1c levels exceeding 8% among diabetic patients appear to significantly cause prominent elevation in ischemic stroke occurrence risk, whereas maintaining HbA1c within the 6.8 to 7.0% range accompany with less potential risk for ischemic stroke events.