Differential Effects of Admission Hemoglobin A 1c by Estimated Glomerular Filtration Rate Stages on Mortality in Acute Ischemic Stroke and Diabetes

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Background The relationship between admission hemoglobin A 1c (HbA 1c ) levels, estimated glomerular filtration rate (eGFR) stages, and early outcomes may provide key insights into the need for individualized glycemic control based on kidney function in patients with ischemic stroke and diabetes. Methods We analyzed data from a multicenter, nationwide, prospective stroke registry in South Korea, including patients with ischemic stroke within 7 days of onset and diabetes. Admission HbA 1c levels (prestroke glycemic status) were categorized as <6.0%, 6.0% to 7.0%, 7.0% to 8.0%, and ≥8.0%. eGFR stages were classified from stage 1 to stage 5 based on the Kidney Disease: Improving Global Outcomes 2021 guidelines. The primary outcome was 3‐month all‐cause mortality. Cox proportional hazards models were performed and an interaction term between eGFR stages and HbA 1c groups was included to evaluate potential effect modification. Results A total of 27 496 patients (age, 69.6±11.4 years; men, 60.3%) were included. The 3‐month cumulative all‐cause mortality rates differed significantly by admission HbA 1c levels: 8.9% in HbA 1c <6.0% versus 5.3% in HbA 1c ≥8.0%. In adjusted analyses, while no association between HbA 1c <6.0% and mortality was observed among eGFR stages, higher HbA 1c levels (7.0%–8.0% in eGFR stages 1, 3, and 5, and ≥8.0% in stages 2 and 5) were significantly associated with increased mortality risk. Notably, in stage 4, there was no significant association between HbA 1c and mortality ( P =0.027 for interaction). Conclusions The association between admission HbA 1c and 3‐month mortality varied among eGFR stages. These findings suggest that eGFR stage may need to be considered when tailoring glycemic control strategies in patients with ischemic stroke and diabetes.

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