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.

[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 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.