Pathophysiological Links Between Stroke and Patients with Prediabetes: Protocol for A Systematic Review (Preprint)
Authors: Naicker Yerushka , Khathi Andile 
Published: April 2024

BACKGROUND

Type 2 Diabetes Mellitus (T2DM) and stroke are significant public health concerns globally. T2DM is characterized by insulin resistance and elevated blood glucose levels, while stroke results from the sudden interruption of blood supply to the brain. T2DM is a well-established risk factor for stroke, but the relationship between prediabetes and stroke is less understood. Prediabetes, an intermediate hyperglycaemic state, precedes T2DM and is associated with an increased risk of stroke.

OBJECTIVE

Primary objectives:
•	To identify and explore the potential mechanisms underlying the relationship between prediabetes and stroke.
•	To determine the changes in stroke biomarker concentrations, including but not limited to CRP, fibrinogen and S100B in prediabetic patients globally.
Secondary objective:
•	To assess the impact of prediabetes on stroke outcome.

METHODS

This systematic review protocol follows the PRISMA-P 2020 guidelines. The systematic review will focus on prospective observational studies, case-control, cohort, and cross-sectional studies examining the link between type 2 diabetes, prediabetes, and stroke risk in individuals aged over 25. Prediabetes will be diagnosed using ADA criteria and stroke diagnosis will follow clinical criteria, with imaging confirmation if possible. The search strategy will include articles published from 2001 to 2024, using PubMed, Google Scholar, and PubMed MeSH terms, supplemented by manual screening of current reviews and related references. Data extraction, risk of bias assessment, and data synthesis will be conducted following established guidelines. Analysis will include generating forest plots using Review Manager software and assessing the quality of evidence using the GRADE system.

RESULTS

Results and Conclusion
The systematic review will use publicly available data, to be collected following the publication of this protocol. This protocol serves as the foundation for the systematic review that will comprehensively investigate the epidemiological links and pathophysiology of prediabetes and stroke in individuals aged 25 years and older globally. The findings will contribute to a better understanding of the relationship between prediabetes and stroke, interventions to reduce stroke risk in prediabetic individuals and give direction on the research to be done in the city of Durban, South Africa.

CONCLUSIONS

Results and Conclusion
The systematic review will use publicly available data, to be collected following the publication of this protocol. This protocol serves as the foundation for the systematic review that will comprehensively investigate the epidemiological links and pathophysiology of prediabetes and stroke in individuals aged 25 years and older globally. The findings will contribute to a better understanding of the relationship between prediabetes and stroke, interventions to reduce stroke risk in prediabetic individuals and give direction on the research to be done in the city of Durban, South Africa.

CLINICALTRIAL

PROSPERO Registration Number: CRD42024530755.