Impact of Diabetes on Complications, Long Term Mortality and Recurrence in 608,890 Hospitalised Patients with Stroke

Abstract

Background: Patients with diabetes mellitus (DM) have been found to be at an increased risk of suffering a stroke. However, research on the impact of DM on stroke outcomes is limited. Objectives: We aimed to examine the influence of DM on outcomes in ischaemic (IS) and haemorrhagic stroke (HS) patients. Methods: We included 608,890 consecutive stroke patients from the Thailand national insurance registry. In-hospital mortality, sepsis, pneumonia, acute kidney injury (AKI), urinary tract infection (UTI) and cardiovascular events were evaluated using logistic regressions. Long-term analysis was performed on first-stroke patients with a determined pathology (n = 398,663) using Royston-Parmar models. Median follow-ups were 4.21 and 4.78 years for IS and HS, respectively. All analyses were stratified by stroke sub-type. Results: Mean age (SD) was 64.3 (13.7) years, 44.9% were female with 61% IS, 28% HS and 11% undetermined strokes. DM was associated with in-hospital death, pneumonia, sepsis, AKI and cardiovascular events (odds ratios ranging from 1.13-1.78, p < 0.01) in both stroke types. In IS, DM was associated with long-term mortality and recurrence throughout the follow-up: HR max (99% CI) at t = 4108 days: 1.54 (1.27, 1.86) and HR (99% CI) = 1.27(1.23,1.32), respectively. In HS, HR max (t = 4108 days) for long-term mortality was 2.10 (1.87, 2.37), significant after day 14 post-discharge. HR max (t = 455) for long-term recurrence of HS was 1.29 (1.09, 1.53), significant after day 116 post-discharge. Conclusions: Regardless of stroke type, DM was associated with in-hospital death and complications, long-term mortality and stroke recurrence.

Diabetes and stroke: An important complication

“…Diabetes is not only associated with stroke but also with risk of adverse stroke outcome 9,10 . In a study of hospital complications with stroke in Thailand, diabetes was associated with increased risk of sepsis and acute kidney injury, and to a lesser extent with cardiovascular events, with pneumonia and urinary infection, and with in‐hospital mortality 21 . Diabetes increases the likelihood of stroke recurrence, 22 and diabetes, but not prediabetes, has been reported to be associated with increased risk of developing cognitive impairment and dementia, particularly that occurring after stroke 23 …”

“…9,10 In a study of hospital complications with stroke in Thailand, diabetes was associated with increased risk of sepsis and acute kidney injury, and to a lesser extent with cardiovascular events, with pneumonia and urinary infection, and with inhospital mortality. 21 Diabetes increases the likelihood of stroke recurrence, 22 and diabetes, but not prediabetes, has been reported to be associated with increased risk of developing cognitive impairment and dementia, particularly that occurring after stroke. 23 An important cause of stroke is atrial fibrillation, and in a study of this relationship, persons with diabetes, although more likely to be anticoagulated with warfarin than nondiabetic persons with atrial fibrillation, had greater risk of stroke, although with improvement during the period from 1992 to 2019.…”

Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18

“…Compared with nondiabetic patients, diabetic patients have poor functional outcome, worse long-term vascular prognosis, and higher mortality after stroke onset [5]. However, given the inconsistent associations found in previous investigations, no consensus has been reached on the role of diabetes in the occurrence of hemorrhagic stroke (HS) [6][7][8][9][10][11]. Some studies reported no significant relationship between diabetes and HS [7,8], while others showed a significant and positive association [9,10] or found that HS occurs significantly less frequently in patients with diabetes [11].…”

Sex-Related Disparities in the Incidence and Outcomes of Ischemic Stroke among Type 2 Diabetes Patients. A Matched-Pair Analysis Using the Spanish National Hospital Discharge Database for Years 2016–2018

“…As has been previously reported by other authors those suffering diabetes have a higher number of cardiovascular risk factors and concomitant chronic diseases [ 24 , 25 ]. Therefore, the IHM and long-term mortality rate in ischemic stroke patients with diabetes are 1.13-fold and 1.52-fold higher than in those without diabetes [ 26 ]. In addition, as expected, and consistent with findings reported before, older age, renal disease, atrial fibrillation, congestive heart failure, acute myocardial infarction, and dementia are risk factors for IHM [ 12 , 13 , 16 , 26 , 27 ].…”

“…Therefore, no information is available in the SNHDD to evaluate the distribution of Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtype of stroke, nor to quantify stroke severity using the National Institute of Health Stroke Scale/Score (NIHSS) or the degree of disability at discharge in our epidemiological study. However, administrative databases using the ICD coding system have been previously used to investigate stroke in Spain and other countries [ 11 , 12 , 13 , 14 , 26 , 37 ].…”