Association of hemoglobin glycation index with outcomes of acute ischemic stroke in type 2 diabetic patients

Objective This study aimed to investigate the association between the hemoglobin glycation index (HGI) and the prognosis of diabetic patients with ischemic stroke. Methods Data were derived from the Abnormal Glucose Regulation in Patients with Acute Stroke across China (ACROSS-China) registry. Diabetic patients with ischemic stroke were included. HGI was calculated by subtracting the predicted HbA1c based on fasting plasma glucose from the observed HbA1c, and then classified into three groups by the tertiles: low HGI (<-0.62), moderate HGI (-0.62 to 0.35) and high HGI (≥0.36). Outcomes included stroke recurrence, all-cause death and poor outcome at 12 months. Results A total of 976 diabetic patients were included. Low HGI was associated with an increased risk of stroke recurrence and poor outcome (adj.hazard ratio 1.53, 95% confidence intervals (CIs) 1.11-2.12, p = 0.01; and adj.odds ratio 1.64, 95% CI 1.13-2.38, p = 0.01, respectively), and high HGI was associated with an increased risk of poor outcome (adj.odds ratio 1.54, 95% CI 1.06-2.24, p = 0.02), compared with moderate HGI. We found a U-shaped association between HGI and the prognosis. Conclusion Both low HGI and high HGI was associated with an increased risk of poor prognosis in diabetic patients with ischemic stroke, compared with moderate HGI.