Published date: Dec 31 2022

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 17 (2022), Issue No. 4

Pages: 485–497

DOI: 10.18502/sjms.v17i4.12549

Omer Abdalla Elamin AbdelgadirOmer.Abdelgadir91@gmail.comMSc Physiology-Alneelain University

Amal Mahmoud SaeedUniversity of Khartoum, Sudan

Abubaker Shadoul Mohamed FarahUniversity of Khartoum, Sudan

Mohanad Elsebty Mohammed Alhassan AhmedUniversity of Khartoum, Sudan

Mogahid Ahmed Osman FarahUniversity of Khartoum, Sudan

Abdelhadi Ahmed Abdelhadi ElsayedUniversity of Khartoum, Sudan

Awab Abdalhafiz Altahir AhmedelbasheirUniversity of Khartoum, Sudan

Mahmoud Saeed Saad MahgoubUniversity of Khartoum, Sudan

Ahmed Khalafalla Mohamed AhmedUniversity of Khartoum, Sudan

Background: Hemoglobin A1C (HbA1c) levels are known to be linked to a higher risk of stroke. However, no research data is available on the impact of HbA1C on the severity of acute ischemic stroke in Sudan.
Methods: This study is a descriptive, cross-sectional hospital-based study of 40 cases of acute ischemic stroke. Ischemic stroke was confirmed using computed tomography (CT) scan at admission; all subjects’ blood HbA1C levels were also measured. Participants were divided into two subgroups based on HbA1C at admission, good glycemic control (GGC) (<7 HbA1C) and poor glycemic control (PGC) (>7 HbA1C), and neurological impairment was assessed using the National Institutes of Health Stroke Scale (NIHSS).
Results: The age distribution of the participants was 45-85 years, with an average age of 63.5±9.2 years with the highest frequency (67.5%) in the age group of 55-75 years. PGC had a statistically significant high HbA1C value of 8.9±1.3 (P=0.000), when compared to GGC subgroups 5.1±0. The association between stroke severity and HbA1C levels on admission in this study was statistically significant (P value=0.005), on admission (78.6%) PGC had moderate to severe stroke (> 18.8 NIHSS) versus (33.3%) that of the GGC (>10.4NIHSS). The frequency of elevated HbA1C levels in patients with acute ischemic stroke was 70% in this study.
Conclusion: PGC was shown to be linked to the occurrence of stroke and to its severity.

Keywords: ischemic stroke, HbA1C, NIHSS

[1] Feigin, V. L., Forouzanfar, M. H., Krishnamurthi, R., Mensah, G. A., Connor, M., Bennett, D. A., Moran, A. E., Sacco, R. L., Anderson, L., Truelsen, T., O’Donnell, M., Venketasubramanian, N., Barker-Collo, S., Lawes, C. M., Wang, W., Shinohara, Y., Witt, E., Ezzati, M., Naghavi, M., …Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group. (2014). Global and regional burden of stroke during 1990-2010: Findings from the global burden of disease study 2010. Lancet, 383, 245–254. https://doi.org/10.1016/S0140- 6736(13)61953-4

[2] Tran, J., Mirzaei, M., Anderson, L., & Leeder, S. R. (2010). The epidemiology of stroke in the Middle East and North Africa. Journal of the Neurological Sciences, 295, 38–40. https://doi.org/10.1016/j.jns.2010.05.016

[3] Sid-Ahmed, F. M., Tag-Eldin, O. S., Idris, M. N. A. (1999, April). Acute CVA in Sudanese patients. Sudan Medical Journal, 37(2).

[4] Elmadhoun, W. M., Noor, S. K., Ibrahim, A. A., Bushara, S. O., & Ahmed, M. H. (2016). Prevalence of diabetes mellitus and its risk factors in urban communities of north Sudan: Population-based study. Journal of Diabetes, 8(6), 839–846. https://doi.org/10.1111/1753-0407.12364

[5] Elbagir, M. N., Eltom, M. A., Elmahadi, E. M., Kadam, I. M., & Berne, C. (1996). A population-based study of the prevalence of diabetes and impaired glucose tolerance in adults in northern Sudan. Diabetes Care, 19(10), 1126– 1128. https://doi.org/10.2337/diacare.19.10.1126

[6] Elbagir, M. N., Eltom, M. A., Elmahadi, E. M., Kadam, I. M., & Berne, C. (1998). A high prevalence of diabetes mellitus and impaired glucose tolerance in the Danagla community in northern Sudan. Diabetic Medicine, 15(2), 164–169. https://doi.org/10.1002/(SICI)1096-9136(199802)15:2<164::AIDDIA536> 3.0.CO;2-A

[7] Classification and Diagnosis of Diabetes. (2017). 2. Classification and Diagnosis of Diabetes. Diabetes Care, 40(Suppl 1), S11–S24. https://doi.org/10.2337/dc17-S005

[8] Elbagir, M. N., Etayeb, N. O., Eltom, M. A., Mahadi, E. O., Wikblad, K., & Berne, C. (1999). Health-related quality of life in insulin-treated diabetic patients in the Sudan. Diabetes Research and Clinical Practice, 46(1), 65–73. https://doi.org/10.1016/S0168- 8227(99)00075-3

[9] Abdelgadir, M., Elbagir, M., Eltom, A., Eltom, M., & Berne, C. (2003). Factors affecting perinatal morbidity and mortality in pregnancies complicated by diabetes mellitus in Sudan. Diabetes Research and Clinical Practice, 60(1), 41– 47. https://doi.org/10.1016/S0168-8227(02)00277-2

[10] Abdelgadir, M., Shebeika, W., Eltom, M., Berne, C., & Wikblad, K. (2009). Health related quality of life and sense of coherence in Sudanese diabetic subjects with lower limb amputation. The Tohoku Journal of Experimental Medicine, 217(1), 45– 50. https://doi.org/10.1620/tjem.217.45

[11] Eliadarous, H. (2017, Aug 10). Exploring the impact of diabetes in Sudan: Out-ofpocket expenditure and social consequences of diabetes on patients and their families. Instförfolkhälsovetenskap/Dept of Public Health Sciences.

[12] National Institute of Health, Institute of Neurological Disorder and Stroke. Stroke Scale.

[13] Ali, A. A., Abdel Rahim, H. M., Almobasher, B., Badi, R. M., Alborai, A., Hussein, A., Awad, K. M., Taha, E. H., Elmagzoub, A. A., & Musa, O. A. (2018). Reference range of hemoglobin A1c in Khartoum State. Anatomy Physiology & Biochemistry International Journal (APBIJ), 4(4), 55564. https://doi.org/10.19080/APBIJ.2018.04.555644

[14] American Diabetes Association. (2018). 6. Glycemic targets: Standards of medical care in diabetes-2018. Diabetes Care, 41(Suppl 1), S55– S64. https://doi.org/10.2337/dc18-S006

[15] El Tallawy, H. N., Farghaly, W. M., Badry, R., Hamdy, N. A., Shehata, G. A., Rageh, T. A., Metwally, N. A., Hassan, E. M., Elsayed, S. S., Yehia, M. A., & Soliman, W. T. (2015). Epidemiology and clinical presentation of stroke in Upper Egypt (desert area). Neuropsychiatric Disease and Treatment, 11, 2177–2183.

[16] Zafar, A., Al-Khamis, F. A., Al-Bakr, A. I., Alsulaiman, A. A., & Msmar, A. H. (2016, July). Risk factors and subtypes of acute ischemic stroke. A study at King Fahd Hospital of the University. Neurosciences (Riyadh), 21(3), 246– 251. https://doi.org/10.17712/nsj.2016.3.20150731

[17] Lindsberg, P. J., Roine, R. O. (2004). Hyperglycemia in acute stroke. Stroke, 35, 363.

[18] Rehman, N., Alam, M., Rehman, K. (2017). Ischemic stroke; frequency of raised Hemoglobin A1C in patients presenting with ischemic stroke. The Professional Medical Journal, 24(11), 1761–1769.

[19] Abdalgbar, A. A., Altalhi, H. G. K. (2019). Glycated hemoglobin level is significantly associated with the severity of ischemic stroke in Libyan non diabetic and diabetic patients. ARC Journal of Nutrient and Growth, 5(1).

[20] Sivakumar, S. (2019). “Clinical outcome in ischemic stroke patients with hyperglycemia.” IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), 18(2), 30-39.

[21] Mi, D., Wang, P., Yang, B., Pu, Y., Yang, Z., & Liu, L. (2017). Correlation of hyperglycemia with mortality after acute ischemic stroke. Therapeutic Advances in Neurological Disorders, 11, 175628561773168.