The role and importance of insulin sensitivity (IS) and related atherogenic conditions in ischemic stroke have not yet been elucidated. Therefore, our study was aimed to analyze (a) IS and plasma insulin (PI) (b) lipoproteins (c) plasminogen activator inhibitor 1 (PAI-1) levels (d) inflammatory markers, hs-C reactive protein (hs CRP) and interleukin-6 (IL-6) levels (e) abdominal obesity, in 40 type 2 diabetics (T2D) with ischemic stroke (group A), 35 T2D without ischemic stroke (group B), 35 nondiabetics with ischemic stroke (group C) and 34 healthy controls (group D).

Ischemic stroke was confirmed by clinical and neuroimaging criteria. IS levels were determined by the frequently sampled intravenous glucose tolerance (FSIGT) test with minimal model analysis (Si index). Total cholesterol, HDL-cholesterol (HDL-c), and tryglicerides concentracion were determined with the chromatography metod. LDL-cholesterol (LDL-c) concentrations were calculated using the Friedewald formula. Plasma PAI-1 activity was determined by plasminogen chromogenic plasmin substrate assay. Hs-CRP was determined by Olympus Analyzer and interleukin 6 (IL-6) levels were measured by ELISA method. Waist circumference was measured at the midpoint between the lower border of the rib cage and the iliac crest.

Si levels were significantly lower in group A vs B (1.15+/−0.46 vs 2.81+/−0.65min-1/mU/lx104; p<0.001) and in C vs D (3.12+/−0.77 vs 6.10+/−1.64min-1/mU/lx104; p<0.001). However, PI levels were higher in group A vs B (19.96+/−4.10 vs 14.84+/−1.73mU/l; p<0.001) and in C vs D (16.14+/−2.20 vs 7.76+/−2.08mU/l; p<0.001). Also, LDL-c and PAI-1 were significantly higher in group A vs B (5.21±0.42vs 4.12±0.53mmol/l; p<0.001), (7.73+/−1.04 vs 4.58+/−0.66mU/l; p<0.001) and in C vs D (4.24±0.53 vs 3.66±0.52mmol/l; p<0.001), (4.60+/−0.64 vs 3.40+/−1.23mU/l; p<0.001). Simultaneously, hs CRP and IL-6 levels were significantly higher in A vs B [16.02±2.23 vs 9.78 ±1.95g/l p<0.05; 20.14±4.56 vs 14.98+/−5.04pg/ml p<0.05] and C vs D [7.54±0.67 vs 2.50±0.32g/l p<0.01; 11.45±6.26 vs 3.36+/−1.44pg/ml p<0.01]. Also, waist circumference was higher in group A vs B (103,26 +/−2,56 vs 93,97 +/−9,51; p<0.01), and in C vs D (101,00 +/−1,27 vs 84,19 +/−1,45; p <0.001). The changes in Si significantly correlated with LDL-c, PAI-1, hs-CRP, IL-6 levels and waist circumference, both in T2D (r=−0.388 r=−0.376 r=−0.368 r=−0.413 r=−0.403, p<0.05) and nondiabetics (r=−0.398 r=−0.369 r=−0.372; r=−0.432 r=−0.394, p<0.05).

Our results demonstrated that decreased IS are associated with increased LDL-c, decreased PAI-1, together with higher hs-CRP, IL-6 levels and waist circumference, both in T2D and nondiabetics. These results imply that decreased IS in association with compensatory hyperinsulinemia, underlying the development of the ischemic stroke, through potentiation of dislipidemia, hypofibrinolisis, low-grade inflammation and abdominal obesity.