Insulin resistance before stroke may affect recovery in diabetes
Treating insulin resistance before a stroke may be more important for recovery than lowering blood sugar. This is shown by a new study on mice from Karolinska Institutet, published in the journal Diabetes. The results suggest that low-grade inflammation may be a contributing factor.
Decreased insulin sensitivity (insulin resistance) and increased blood sugar are main features of type 2 diabetes that are closely linked to greater disabilities after a stroke. The study reports that increasing insulin sensitivity prior to a stroke leads to better functional recovery than focusing on blood‑sugar control alone. The work reframes a long‑standing question in diabetes and stroke care: is it the sugar, or the resistance to insulin, that matters most for a better prognosis after stroke?
In the study, researchers compared pre‑stroke strategies that lowered glucose with approaches that improved insulin sensitivity. Mice whose insulin sensitivity was improved showed improved neurological function compared with animals treated to reduce blood glucose alone.
“While hyperglycemia (increased blood sugar) has been a traditional target, the findings suggest that insulin resistance may be a more suitable treatment target to minimise disability after stroke in diabetes”,says Ellen Vercalsteren, Postdoc at the Department of Clinical Science and Education, Södersjukhuset, who has conducted important experiments in the study.
“Stroke remains a leading cause of long‑term disability, and many survivors live with diabetes or prediabetes. If replicated in people, insulin‑sensitizing strategies through lifestyle or medications could become a new preventive approach to improve stroke prognosis in people with metabolic diseases such as diabetes”, continues Vladimer Darsalia, Principal Researcher at the Department of Clinical Science and Education, Södersjukhuset.
The study has been conceived by Vladimer Darsalia and Cesare Patrone at Department of Clinical Science and Education, Södersjukhuset, and is the result of a collaborative effort with the Internal Medicine Unit at Södersjukhuset and Boehringer Ingelheim Pharma GmbH & Co in Germany.
Funders of the study were The Swedish Research Council, Diabetesfonden, STROKE-Riksförbundet, ALF, Hjärnfonden, Frimurarestiftelse, Ulla Hamberg Angeby och Lennart Angebys Stiftelse and the Swedish Heart-Lung foundation.
Publication
Normalization of Insulin Resistance, Rather Than Hyperglycemia, Before Stroke Improves Functional Outcomes in a Mouse Model of Type 2 Diabetes. Ellen Vercalsteren, Dimitra Karampatsi, Maria Neicu, Mihaela Oana Romanitan, Thomas Nyström, Thomas Klein, Cesare Patrone, Vladimer Darsalia. Diabetes 2026; db250532. doi.org/10.2337/db25-0532