Diabetes, hyperglycemia and the management of cerebrovascular disease.
OBJECTIVE
Hyperglycemia is frequent in patients with cerebrovascular disease. This review article aims to summarize the recent evidence from observational studies that examined the adverse cerebrovascular effects of dysglycemic states as well as interventional studies assessing intensive management strategies for hyperglycemia.


RESULTS
In recent years, diabetes, prediabetic states and insulin resistance and their association with cerebrovascular disease were an important focus of research. The cerebrovascular consequences of these metabolic abnormalities were found to extend beyond ischemic stroke to covert brain infarcts, other structural brain changes and to cognitive impairment with and without dementia. Interventional studies did not reveal that more intensive management of chronic hyperglycemia and of hyperglycemia in the setting of acute stroke improves outcome. There is clear evidence, however, that the overall management of multiple risk factors and behavior modification in patients with dysglycemia may reduce the burden of cerebrovascular disease.


CONCLUSIONS
Observational studies reveal the growing burden and adverse cerebrovascular effects of dysglycemic states. Currently available interventional studies assessing more intensive strategies for the management of hyperglycemia did not prove, however, to be effective. We discuss the current evidence, pathophysiological considerations and management implications.
Stroke Center, Department of Neurology, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Salo
S
Haratz
David
D
Tanne
D001921:Brain / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000473:pathology / Q000628:therapy*; D002986:Clinical Trials as Topic; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D017281:Cost of Illness; D003920:Diabetes Mellitus / Q000473:pathology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000473:pathology / Q000628:therapy*; D006801:Humans; D006943:Hyperglycemia / Q000473:pathology / Q000628:therapy*; D007333:Insulin Resistance / Q000502:physiology; D024821:Metabolic Syndrome / Q000503:physiopathology; D011236:Prediabetic State / Q000473:pathology / Q000628:therapy; D020521:Stroke / Q000209:etiology