Diabetes in ischaemic stroke in a regional Australian hospital: uncharted territory

Abstract

Background Stroke and diabetes mellitus (DM) are significant interrelated healthcare issues but there is a dearth of data on the prevalence of DM among Australia's regional stroke population. Aims We aimed to determine the prevalence of DM in stroke patients at a large regional centre, including subanalyses on stroke subtypes, glycaemic control and renal function in ischaemic stroke (IS). Methods We conducted a retrospective analysis of all patients (n = 323) with IS or transient ischaemic attack (TIA) admitted to Ballarat Base Hospital from January 2015 to December 2016. Demographic data, cardiovascular risk factors, aetiology/territory of IS, pre‐morbid DM status, indicators of glycaemic control and renal impairment were recorded. Results DM was present in 28.5% of IS and TIA patients, including 4% being newly diagnosed. Among diabetic IS patients, 45.3% had poor glycaemic control (HbA1c ≥7.0%) while 16% had moderate to severe renal impairment (estimated glomerular filtration rate of <30). The majority of IS were partial anterior circulation stroke (53.4%) and cardioembolism was the commonest mechanism (43.5%). We found no significant association between DM and a specific stroke location or mechanism. Conclusions Almost one‐third of IS/TIA patients had DM, with a significant proportion showing poor glycaemic control. The DM prevalence in our cohort was comparable with reported rates from other developed countries. Although we found no association between DM and a particular stroke type or mechanism, it is likely a reflection of our cohort size. Our study demonstrated that DM, as a significant risk factor in IS, warrants early detection and better management strategies.

Diabetes Mellitus among Patients with Acute Ischemic Stroke Admitted to the Department of Medicine in a Tertiary Care Center

“…This finding is concomitant with the study in Australia. 15 However, the study of the USA (64%) and Italy (65.2%) reported a higher prevalence of poorly controlled diabetes mellitus in stroke patients than our study. 15 This might be due to differences in the size of studies and medication adherence.…”

“… 15 However, the study of the USA (64%) and Italy (65.2%) reported a higher prevalence of poorly controlled diabetes mellitus in stroke patients than our study. 15 This might be due to differences in the size of studies and medication adherence. The poor glycemic control in diabetes mellitus was found to have worsened the functional outcomes; and increased stroke severity, mortality rate, and stroke recurrence.…”

“…The findings are in concordance with the results of a study conducted in the South Western community of Nepal and Australia. 14,15 Among acute ischemic stroke patients with diabetes mellitus, more than half 76% had hypertension and it is higher in comparison to those without diabetes 58.25%. The finding is supported by the previous study which revealed that hypertension proportion has been increasing over time for both with or without diabetes mellitus, but 16 Diabetes mellitus in our acute ischemic stroke patients is in poor glycemic control with 44% having HbA1C level ≥7%.…”

Ischemic stroke subtypes in subjects with and without diabetes: data from two hospitals in Mongolia

“…Coronary artery disease increases the risk of ischemic stroke at all ages, with the highest risk among African-Americans under 55 and whites under 65, according to a study by Kissela et al (2005). In a large case-control study adjusted for multiple risk factors, the risk of stroke was 2.3 to 2.47-fold higher in patients with diabetes (Hu et al, 2022;Kissela et al, 2005). The TOAST classification system of the stroke subtype is easy to use and includes good observer agreement with experts.…”