The association of hypoglycemia with stroke risk: A systematic review and meta-analysis
Keywords:
hypoglycemia, mortality, risk, strokeAbstract
Background and aim: The prevalence of stroke continues to increase worldwide, and optimal glucose control remains an important component of acute stroke management. However, the occurrence of hypoglycemia in patients with stroke, particularly hypoglycemia-induced stroke mimics, and its association with mortality remain controversial. This study was conducted to evaluate the occurrence of hypoglycemia in stroke patients, and to assess its association with mortality.
Methods: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420261306540). PubMed, Scopus, ScienceDirect, Taylor and Francis, ProQuest, EBSCO, and Springer were searched for English-language observational studies involving adults.
Results: A total of 11 studies with 2,024,725 participants were involved. Hypoglycemia was significantly correlated with an increased risk of stroke, with a relative risk (RR) of 1.73 (95% confidence interval [CI]: 1.35–2.22; 95% prediction interval [PI]: 0.81–3.69; p < 0.01). Inter-subgroup analysis showed that severe hypoglycemia (SH) increased the risk by twofold compared to non-severe hypoglycemia (NSH) RR 1.96 (95%CI: 1.38-2.78; p <0.01). In contrast, mild hypoglycemia did not significantly increase the risk of stroke compared to normoglycemia (RR 1.27; 95% CI: 0.79-2.05; p = 0.32). In terms of mortality, hypoglycemia increased the risk of mortality (RR 2.42; 95% CI: 1.59-3.68; p <0.01). Across the analyzed comparisons, severe hypoglycemia was generally associated with higher stroke and mortality risks (RR 2.56; 95%CI: 1.36-4.81; p <0.01).
Conclusion: Hypoglycemia is significantly associated with increased risks of stroke and mortality, with the greatest impact observed in SH episodes, underscoring the clinical importance of preventing SH.
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