Optimizing management of ischemic stroke and type 2 diabetes: A retrospective study of NIHSS scores and HbA1c levels

BACKGROUND Cerebral infarction complicated by type 2 diabetes mellitus (T2DM) is associated with high disability and mortality rates.Traditional treatments fail to dynamically integrate neurological function with blood glucose levels.This study aimed to explore the efficacy of an optimized dual-target individualized strategy.AIM To investigate the clinical efficacy and prognostic impact of a dual-target personalized treatment strategy based on the National Institutes of Health Stroke Scale (NIHSS) score and glycated hemoglobin (HbA1c) in patients with cerebral infarction and T2DM.METHODS A retrospective study was conducted among 116 patients with cerebral infarction and T2DM admitted between January 2020 and December 2025.Patients were divided into a conventional and an optimized treatment group, each comprising 58 patients.The conventional treatment group received standard care for cerebral infarction combined with a fixed baseline glycemic control regimen.The optimized treatment group, in addition to standard care, received stratified interventions for neurological function based on NIHSS scores and stratified glycemic control according to HbA1c levels, with dynamic adjustments to the treatment and rehabilitation plans.NIHSS scores, HbA1c levels, complication rates, 3-month cerebral infarction recurrence rates, and prognostic outcomes were compared between the two groups before and after treatment.Multivariable binary logistic regression analysis was used to identify independent associations between the optimized treatment regimen and favorable outcomes.Receiver operating characteristic curves were used to evaluate the prognostic performance of NIHSS scores, HbA1c levels, and their combination. / 35 RESULTSAt 4 weeks and 3 months, both the NIHSS score and HbA 1 c levels in the optimized treatment group were lower than those in the conventional treatment group (P < 0.05 for both).The overall complication rate and 3-month recurrence rate in the optimized treatment group were 12.07% and 5.17%, respectively, lower than the corresponding rates of 29.31% and 17.24% in the conventional treatment group; the rate of favorable 3month outcomes was 79.31%, higher than the 51.72% observed in the conventional treatment group (P < 0.05 for both).Multivariable logistic regression analysis showed that, after adjusting for age, baseline NIHSS score, baseline HbA1c, duration of T2DM, hypertension, and hyperlipidemia, the optimized treatment regimen was independently associated with a favorable 3-month prognosis (adjusted odds ratio = 3.801, 95% confidence interval: 1.593-9.071,P = 0.003).The area under the curve for predicting prognosis using the combination of NIHSS score and HbA1c was 0.872, which was higher than that of either individual indicator.CONCLUSION Individualized dual-target therapy based on the NIHSS score and HbA1c can improve neurological function and glycemic control in patients with cerebral infarction and T2DM, reduce the risks of complications and recurrence, and improve short-term prognosis.