Association between prediabetes and higher risk of mortality following acute ischemic stroke: A meta-analysis

doi:10.4239/wjd.v17.i1.110528

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Jan 15, 2026 (publication date) through Jan 14, 2026

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World Journal of Diabetes

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Meta-Analysis

World J Diabetes. Jan 15, 2026; 17(1): 110528
Published online Jan 15, 2026. doi: 10.4239/wjd.v17.i1.110528

Association between prediabetes and higher risk of mortality following acute ischemic stroke: A meta-analysis

Bhavin Patel, Kshitij Mahajan, Arankesh Mahadevan, Rishika Trivedi, Avleen Dhingra, Samrath Singh Brar, Sakshi Dixit, Rupak Desai

Bhavin Patel, Department of Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI 48341, United States

Kshitij Mahajan, Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, United States

Arankesh Mahadevan, Department of Neurology, University of Utah Health, Salt Lake City, UT 84132, United States

Rishika Trivedi, Department of Internal Medicine, DHR Health, Edinburg, TX 78539, United States

Avleen Dhingra, Department of Medicine, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India

Samrath Singh Brar, Department of Internal Medicine, Trinity Health Livonia Hospital, Livonia, MI 48154, United States

Sakshi Dixit, Department of Internal Medicine, Cleveland Clinic Akron General Medical Center, Akron, OH 44307, United States

Rupak Desai, Outcomes Research, Independent Researcher, Atlanta, GA 30033, United States

Co-corresponding authors: Arankesh Mahadevan and Rupak Desai.

Author contributions: Patel B and Mahajan K acquired and curated data; Patel B, Mahajan K and Desai R conceived and designed the study; Mahadevan A, Trivedi R and Dhingra A drafted the manuscript; Mahadevan A and Desai R drafted the manuscript, performed formal analysis, provided resources and supervision as the co-corresponding authors; Brar SS and Dixit S performed verification; all authors reviewed and approved the final manuscript.

Conflict-of-interest statement: The authors declare no conflicts of interest related to this work.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Rupak Desai, MBBS, Outcomes Research, Independent Researcher, Scottdale, Atlanta, GA 30033, United States. drrupakdesai@gmail.com

Received: June 9, 2025
Revised: September 19, 2025
Accepted: November 12, 2025
Published online: January 15, 2026
Processing time: 220 Days and 1.9 Hours

Abstract

BACKGROUND

Prediabetes increases the risk of cardiovascular and cerebrovascular mortality. This study examines the relationship between prediabetes and mortality in post-stroke patients.

AIM

To determine whether prediabetes is associated with increased post-stroke mortality in adults with acute ischemic stroke (IS).

METHODS

A systematic search was conducted in PubMed/MEDLINE, Scopus, and Google Scholar databases until May 2023 to identify relevant articles reporting on the association of prediabetes with IS mortality. A random-effects model was used to calculate odds ratio (OR), heterogeneity was assessed using I² statistics, and sensitivity analysis was performed using the leave-one-out method.

RESULTS

Our analysis of 11 studies included 84833 prediabetic patients with a mean follow-up time of 20.9 months. The prediabetes cohort comprised patients of an average age of 67 years from various countries, including Korea, Italy, Japan, China, Spain, and the Netherlands. Although, the unadjusted analysis showed no significant association between prediabetes and post-stroke mortality (OR = 1.06, 95%CI: 0.51-2.19) with high heterogeneity (I² = 94.7%, P < 0.01). Post-adjustment for baseline characteristics and comorbidities, the prediabetes cohort exhibited a significantly higher risk of post-stroke mortality (adjusted OR = 1.68, 95%CI: 1.29-2.19) with moderate heterogeneity (I² = 49.45%, P = 0.03). Subgroup analysis by country revealed non-significant higher odds of mortality in Korea, Italy, Spain, Japan, and the Netherlands, indicating the need for more extensive studies.

CONCLUSION

Our findings suggest that prediabetes is associated with a nearly 68% higher mortality risk following a stroke. Thereby warranting more prospective studies with prediabetes to validate these findings.

Keywords: Meta-analysis; Prediabetes; Hyperglycemia; Stroke; Mortality

Core Tip: This meta-analysis synthesizes 11 studies (> 84000 participants) evaluating whether prediabetes is associated with mortality after acute ischemic stroke. Unadjusted results were heterogeneous; however, adjusted analyses showed a significant association between prediabetes and higher poststroke mortality. These findings support early identification of prediabetes after stroke and emphasize rigorous secondary prevention while definitive interventional studies are pursued.