Primary And Secondary Prevention In Stroke: Approact To Diabetes Mellitus Cases

Microangiopathy and m acroangiopathy are induced by increased the tendency of atherosclerosis caused by metabolic impairment. The prerevalance of diabetes mellitus is 15 - 33 % in cases with ischemic stroke. Diabetes mellitus is an independent risk factor especially for stroke an d it can increase the relative risk (RR) 1.8 - 6 times for initial stroke. The risk of ischemic stroke is higher in women with diabetes. Individual adjustment of glycemic targets is performed but treatment regulation as to set ≤ 7.0 % of HbA1C is recommended for decreasing the microvascular and macrovascular complications if the history of stroke or TIA are present. The targeted fasting plasma glucose levels should be ranged from 4.0 to 7.0 mmol/L and the targeted plasma glucose levels at postprandial second hour should be ranged from 5.0 to 10.0 mmol/L. Daily physial activity, weight control, blood pressure control, lipid control and life style changes are recommended to all diabetic patients. Also, medical treatment is commonly needed for targeted HbA1C levels. In diabetic patients, Metformin is an effective first - line pharmacotherapy to decrease the stroke risk. Also, monotherapy with fibrates can be considered. It is proposed to set the blood preassure at < 130/80 mmHg with AC EI or ARB hypertension treatments in diabetic patients. Diabetic adults with additionally risk factors should be treated with statins to decrease the risk of initial stroke. The benefit of antiagregant usage to decrease the stroke risk is not clear yet, ho wever aspirin usage can suitable in diabetic patients with increased cardiovascular event risk