Our findings suggest that ischemic stroke patients with T1D or T2D exhibit a distinct risk-factor and etiologic profile and a worse vascular prognosis than do nondiabetic patients.

OBJECTIVEType 1 diabetes is associated with a markedly increased risk of stroke, but only a few studies on the incidence of stroke in type 1 diabetes exist. Therefore, we assessed the incidence of stroke in patients with type 1 diabetes and studied the impact of diabetic nephropathy (DN) and severe diabetic retinopathy (SDR) on this risk.RESEARCH DESIGN AND METHODSWe studied 4,083 patients with type 1 diabetes from the Finnish Diabetic Nephropathy Study. Mean age was 37.4 ± 11.8 years, duration of diabetes was 21.6 ± 12.1 years, and 52% were men. Strokes were identified from medical records, death certificates, and the National Hospital Discharge Register and classified based on medical files and brain images.RESULTSDuring 36,680 person-years of follow-up, 149 (4%) patients suffered an incident stroke (105 infarctions and 44 hemorrhages). Of the infarctions, 58 (55%) were lacunar. The incidence of stroke, cerebral infarction, and cerebral hemorrhage was 406 (95% CI 344–477), 286 (234–347), and 120 (87–161) per 100,000 person-years, respectively. In an adjusted analysis, microalbuminuria increased the risk of stroke with a hazard ratio (HR) of 3.2 (1.9–5.6), macroalbuminuria 4.9 (2.9–8.2), and end-stage renal disease 7.5 (4.2–13.3), and SDR increased the risk with an HR of 3.0 (1.9–4.5). The risk of cerebral infarction, cerebral hemorrhage, and lacunar infarction increased in a similar manner. The proportion of lacunar versus nonlacunar infarction did not change across DN groups.CONCLUSIONSThe presence of SDR and DN, independently, increases the risk of stroke, cerebral infarction, and cerebral hemorrhage in patients with type 1 diabetes.

Despite their different associated risk factors in our young patient cohort, both low and high eGFR predicted long-term mortality after ischemic stroke.

W orldwide, cerebrovascular disease is the second leading cause of death not only in high-income but also in lowincome countries. Patients with type 1 diabetes mellitus have a markedly increased risk of stroke compared with nondiabetic subjects, 1 and it is of note that these patients are at a high risk of stroke 10 to 15 years earlier than nondiabetic subjects. 2 Age, hypertension, atrial fibrillation, smoking, and diabetes mellitus are well-known risk factors for stroke in the general population. [2][3][4][5] In patients with type 2 diabetes mellitus, similar risk factors have been observed. 6 Furthermore, the metabolic syndrome and its components have also been shown to increase the risk of stroke, especially in patients with type 2 diabetes mellitus. Although the risk factors for stroke in patients with type 2 diabetes mellitus have been assessed in several studies, few studies on the risk factors for stroke and stroke subtypes in patients with type 1 diabetes mellitus exist. No sex difference has been observed for the risk of stroke in type 1 diabetes mellitus, which is in contrast to the general population in which premenopausal women are protected from cardiovascular disease and stroke.1,2 Stroke is usually divided into 2 subgroups: ischemic stroke and hemorrhagic stroke. Ischemic stroke can be further subgrouped into lacunar and nonlacunar infarction, whereas hemorrhagic stroke includes intracerebral and subarachnoid hemorrhage. We have earlier shown that both the severity of diabetic nephropathy (DN) and the presence of severe diabetic retinopathy (SDR) increase the risk of any stroke, ischemic stroke, lacunar infarction, and hemorrhagic stroke. 8 However, comprehensive studies on independent risk factors for each subtype of stroke are still missing.Therefore, we aimed to study the independent risk factors for stroke, and also for the subtypes ischemic stroke, lacunar Background and Purpose-Despite the fact that patients with type 1 diabetes mellitus have a markedly increased risk of experiencing a stroke, independent risk factors for stroke and its subtypes in these patients have remained unclear. Methods-A total of 4083 patients with type 1 diabetes mellitus from the Finnish Diabetic Nephropathy (FinnDiane) Study, without a history of stroke at baseline, were included. Strokes were classified based on medical files and brain imaging. At baseline, mean age was 37.4±11.8 years, duration of diabetes mellitus was 20.0 (11.0-30.0) years, and 51% were men. During 9.0±2.7 years (36 680 patient-years) of follow-up, 105 patients experienced an ischemic stroke and 44 a hemorrhagic stroke. Cox proportional hazards analyses were performed to determine independent risk factors. Results-Independent risk factors for ischemic stroke were duration of diabetes mellitus, presence of diabetic nephropathy, higher hemoglobin A 1c , higher systolic blood pressure, insulin resistance, and history of smoking, whereas sex, lipids, high-sensitivity C-reactive protein, and the metabolic syndrome were not associated with an incre...

OBJECTIVETo assess the prevalence of cerebral small-vessel disease (SVD) in subjects with type 1 diabetes compared with healthy control subjects and to characterize the diabetes-related factors associated with SVD. RESEARCH DESIGN AND METHODSThis substudy was cross-sectional in design and included 191 participants with type 1 diabetes and median age 40.0 years (interquartile range 33.0-45.1) and 30 healthy age-and sex-matched control subjects. All participants underwent clinical investigation and brain MRIs, assessed for cerebral SVD. RESULTSCerebral SVD was more common in participants with type 1 diabetes than in healthy control subjects: any marker 35% vs. 10% (P = 0.005), cerebral microbleeds (CMBs) 24% vs. 3.3% (P = 0.008), white matter hyperintensities 17% vs. 6.7% (P = 0.182), and lacunes 2.1% vs. 0% (P = 1.000). Presence of CMBs was independently associated with systolic blood pressure (odds ratio 1.03 [95% CI 1.00-1.05], P = 0.035). CONCLUSIONSCerebral SVD, CMBs in particular, is more common in young people with type 1 diabetes compared with healthy control subjects.Type 1 diabetes is associated with a fivefold increased risk of stroke (1), with cerebral small-vessel disease (SVD) as the most common etiology (2). Cerebral SVD in type 1 diabetes, however, remains scarcely investigated and is challenging to study in vivo per se owing to the size of affected vasculature (3); instead, MRI signs of SVD are studied. In this study, we aimed to assess the prevalence of cerebral SVD in subjects with type 1 diabetes compared with healthy control subjects and to characterize diabetes-related variables associated with SVD in stroke-free people with type 1 diabetes. RESEARCH DESIGN AND METHODSAll study participants are part of the Finnish Diabetic Nephropathy (FinnDiane) Study (4). Participants attending the Helsinki University Hospital (HUH) study center were consecutively recruited and underwent brain MRI as part of their study visit. In 2011-2017, we studied 191 participants with type 1 diabetes. Inclusion criteria were age 18-50 years and type 1 diabetes onset at age ,40 years. Exclusion criteria were presence of end-stage renal disease, clinical signs of cerebrovascular disease, or contraindications