title: Insulin Resistance and Prognosis of Nondiabetic Patients With Ischemic Stroke: The ACROSS-China Study (Abnormal Glucose Regulation in Patients With Acute Stroke Across China).
abstract: Insulin resistance was common in patients with stroke. This study investigated the association between insulin resistance and outcomes in nondiabetic patients with first-ever acute ischemic stroke.
  
  
  
  Patients with ischemic stroke without history of diabetes mellitus in the ACROSS-China registry (Abnormal Glucose Regulation in Patients With Acute Stroke Across China) were included. Insulin resistance was defined as a homeostatis model assessment-insulin resistance (HOMA-IR) index in the top quartile (Q4). HOMA-IR was calculated as fasting insulin (μU/mL)×fasting glucose (mmol/L)/22.5. Multivariable logistic regression or Cox regression was performed to estimate the association between HOMA-IR and 1-year prognosis (mortality, stroke recurrence, poor functional outcome [modified Rankin scale score 3-6], and dependence [modified Rankin scale score 3-5]).
  
  
  
  Among the 1245 patients with acute ischemic stroke enrolled in this study, the median HOMA-IR was 1.9 (interquartile range, 1.1-3.1). Patients with insulin resistance were associated with a higher mortality risk than those without (adjusted hazard ratio, 1.68; 95% confidence interval, 1.12-2.53;P=0.01), stroke recurrence (adjusted hazard ratio, 1.57, 95% confidence interval, 1.12-2.19;P=0.008), and poor outcome (adjusted odds ratio, 1.42; 95% confidence interval, 1.03-1.95;P=0.03) but not dependence after adjustment for potential confounders. Higher HOMA-IR quartile categories were associated with a higher risk of 1-year death, stroke recurrence, and poor outcome (Pfor trend =0.005, 0.005, and 0.001, respectively).
  
  
  
  Insulin resistance was associated with an increased risk of death, stroke recurrence, and poor outcome but not dependence in nondiabetic patients with acute ischemic stroke.
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Jing
authors.initials: J
authors.lastname: Jing
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Yuesong
authors.initials: Y
authors.lastname: Pan
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Xingquan
authors.initials: X
authors.lastname: Zhao
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Huaguang
authors.initials: H
authors.lastname: Zheng
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Qian
authors.initials: Q
authors.lastname: Jia
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Donghua
authors.initials: D
authors.lastname: Mi
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Weiqi
authors.initials: W
authors.lastname: Chen
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Chunxue
authors.initials: C
authors.lastname: Wang
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Yan
authors.initials: Y
authors.lastname: He
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: David
authors.initials: D
authors.lastname: Wang
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.P., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (J.J., X.Z., H.Z., Q.J., D.M., W.C., H.L., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P., Y.H.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.P., Y.H.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.). yongjunwang1962@gmail.com yilong528@gmail.com.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D002545:Brain Ischemia / Q000097:blood* / Q000453:epidemiology / Q000401:mortality; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data*; D020521:Stroke / Q000097:blood* / Q000453:epidemiology / Q000401:mortality
chemical_list: D001786:Blood Glucose
keywords: diabetes mellitus; insulin resistance; ischemic stroke; outcome; stroke