Association of pre- diabetes and type 2 diabetes mellitus with intracranial plaque characteristics in patients with acute ischemic stroke

Objectives: To investigate the association of pre-diabetes(i.e., the early stages of glucometabolic distur-bance) and Type 2 diabetes mellitus (T2DM) with intrac-ranial plaque characteristics in patients with acute ischemic stroke using three-dimensional high-resolution MR imaging.Methods: One hundred and forty -three symptomatic patients with acute ischemic stroke attribute to intracra-nial atherosclerotic plaque were prospectively enrolled. All participants were further divided into three groups: normal glucose metabolism(non-diabetes) group(n = 41), pre-diabetes group(n = 45), and T2DM group(n = 57) according to glucometabolic status. Culprit plaque characteristics (such as plaque burden, normalized wall index and enhancement ratio), total plaque number, and global plaque enhancement score were analyzed and compared among the three glucometabolic groups. The association between pre-diabetes and T2DM with intrac-ranial plaque characteristics was assessed by logistic regression and multivariate linear regression.Results: Plaque number was higher in patients with pre-diabetes and T2DM compared with those with non-diabetes(3.71 & PLUSMN; 1.83 and 3.75 & PLUSMN; 1.71 vs 2.24 & PLUSMN; 1.46, p = 0.006). Multivariate logistic regression showed a signif-icant association of multiple intracranial plaques with pre-diabetes(OR 3.524, 95% CI 1.082 -11.479, p = 0.037), T2DM(OR 3.760, 95% CI 1.098 -12.872, p = 0.035) and luminal stenotic rate. Both pre-diabetes and T2DM were significantly associated with culprit plaque enhancement ratio(beta = 0.527 and beta = 0.536; respectively; p < 0.001) and global plaque enhancement score(beta = 0.264 and beta = 0.373; respectively; p < 0.05).Conclusions: Patients with pre-diabetes and T2DM had similar intracranial atherosclerotic plaque vulnerability, as demonstrated by multiple plaques, increased culprit plaque enhancement ratio and global plaque enhance-ment score.Advances in knowledge: Pre-diabetes might be a risk factor for intracranial plaque vulnerability. It is necessary to monitor a slight increase in blood glucose in non -diabetes patients with acute ischemic stroke.

Automated summary

The study investigated the association between pre-diabetes and Type 2 diabetes mellitus with intracranial plaque characteristics in patients with acute ischemic stroke. It was found that pre-diabetes and T2DM patients showed similar vulnerability in intracranial atherosclerotic plaques, with increased plaque burden and enhancement ratio. Monitoring blood glucose levels in non-diabetic stroke patients may be necessary to prevent plaque vulnerability.