Ischemic stroke is a leading cause of morbidity and mortality among type 2 diabetic patients. Preclinical and translational studies have identified critical pathophysiological mediators of stroke risk, recurrence, and poor outcome in diabetic patients, including endothelial dysfunction and inflammation. Most clinical trials of diabetes and stroke have focused on treating hyperglycemia alone. Pioglitazone has shown promise in secondary stroke prevention for insulin-resistant patients; however, its use is not yet widespread. Additional research into clinical therapies directed at diabetic pathophysiological processes to prevent stroke and improve outcome for diabetic stroke survivors is necessary. Resilience is the process of active adaptation to a stressor. In patients with diabetes, stroke recovery is impaired by insulin resistance, endothelial dysfunction, and inflammation, which impair key neuroresilience pathways maintaining cerebrovascular integrity, resolving poststroke inflammation, stimulating neural plasticity, and preventing neurodegeneration. Our review summarizes the underpinnings of stroke risk in diabetes, the clinical consequences of stroke in diabetic patients, and proposes hypotheses and new avenues of research for therapeutics to stimulate neuroresilience pathways and improve stroke outcome in diabetic patients.

中文翻译：

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糖尿病、中风和神经弹性：超越高血糖症

缺血性中风是 2 型糖尿病患者发病率和死亡率的主要原因。临床前和转化研究已经确定了糖尿病患者中风风险、复发和不良预后的关键病理生理介质，包括内皮功能障碍和炎症。大多数糖尿病和中风的临床试验都集中在单独治疗高血糖症上。吡格列酮在胰岛素抵抗患者的卒中二级预防中显示出前景；然而，它的使用尚未广泛。有必要对针对糖尿病病理生理过程的临床疗法进行进一步研究，以预防中风并改善糖尿病中风幸存者的预后。复原力是主动适应压力源的过程。在糖尿病患者中，胰岛素抵抗会影响卒中的恢复，内皮功能障碍和炎症，这会损害维持脑血管完整性、解决中风后炎症、刺激神经可塑性和预防神经变性的关键神经弹性通路。我们的综述总结了糖尿病患者中风风险的基础、糖尿病患者中风的临床后果，并提出了假设和新的治疗方法研究途径，以刺激神经弹性通路并改善糖尿病患者的中风结局。