The association of diabetes with ischemic stroke and transient ischemic attacks in a tertiary center in Saudi Arabia

Abstract

BACKGROUND: Diabetes mellitus increases stroke risk 1.5 to 3 fold, particularly ischemic stroke. There is limited literature on the impact of diabetes on stroke patients in Saudi Arabia. OBJECTIVES: Determine the association of diabetes on the presentation, subtypes, in-hospital complications and outcomes of ischemic stroke and transient ischemic attacks (TIA). DESIGN: IRB approved, retrospective chart review. SETTING: Tertiary care center. PATIENTS AND METHODS: All adult patients with ischemic stroke or TIA aged 18 years or older admitted from January 2016 to December 2017 were included. MAIN OUTCOME MEASURES: Stroke severity at presentation, stroke-related complications, discharge disposition and discharge modified Rankin Scale (mRS) in relation to diabetes. SAMPLE SIZE: 802 patients. RESULTS: Among 802 cases, 584 (72.8%) had diabetes; the majority (63.1%) were males. The mean age was younger in the non-diabetic stroke group (54.6 [15.5] years vs. 63.3 [9.9], P <.001). Hypertension (83.6% vs 49.1%, P <.001), dyslipidemia (38.9% vs. 28.9%, P =.009), prior stroke (27.7% vs. 19.3% P =.014), and ischemic heart disease (20.4% vs. 7.8%, P <.001) were more common in diabetic patients whereas smoking was more common (19.3% vs. 11.1%, P =.003) in the non-diabetic patients. The commonest subtype of stroke was large artery disease followed by small vessel disease. Both were more common in diabetic vs. non-diabetic patients (55.8% vs. 44%, P =.003), and (16.6% vs. 11%, P =.05) respectively. Diabetic stroke patients were more likely to have lacunar stroke (16.4% versus 9.2%, P =.009). TIAs occurred more commonly in the non-diabetic group (26.1% vs. 13.7%, P <.001). Non-diabetic patients had a better outcome (mRS score of 0–2) at discharge (62.4% vs. 45.9%, P =.002). CONCLUSIONS: Almost three-fourth stroke patients were diabetic in our cohort. Diabetic stroke patients were older, had multiple vascular comorbid conditions, presented late to the hospital, and were likely to have more disability at the time of discharge. Large vessel atherosclerosis as well as lacunar infarctions were more common in diabetic stroke patients. LIMITATIONS: Missing data about time of presentation in few patients, missing modified Rankin Scale score at discharge. CONFLICT OF INTEREST: None.

Evaluation of stroke pre-hospital management in Lebanon from symptoms onset to hospital arrival and impact on patients’ status at discharge: a pilot study

“…One potential explanation would be that patients who have diabetes might present symptoms congruent with those of stroke, thus they or their caregivers might have interfered based on hypoglycemia and not stroke and this can lead to a misperception and neglection of the seriousness of the condition instead of immediately moving to the ED. This result is consistent with a study done by Homoud et al Where a significant majority of the non-diabetic stroke patients presented to the ED within 3 hours of symptom onset (P = 0.003), whereas almost 38% of diabetic stroke patients presented after 24 hours of symptom onset [31].…”

Prevalence and Clinico-Radiologic Spectrum of Intracranial Atherosclerotic Disease-Related Stroke

“…11,23 Recently published studies focusing the population from SA reported the prevalence of large artery disease subtype as 26% 24 and 52.6% of all admitted AIS patients. 10 However, none of the authors of extant studies examined and described ICAD as a separate category in detail. 10,24 With respect to the sample characteristics, male preponderance in our study is in agreement with the sample compositions in studies conducted in India 25 and China.…”

“…Despite gaining worldwide attention owing to recent advancements in management, literature focusing on ICAD in the Saudi Arabian (SA) context is scarce and insufficient. Nonetheless, evidence gathered from SA indicates that large artery disease (LAD) is common among AIS patients 9,10. As the real burden and clinico-radiological spectrum of ICAD have never been studied in SA, this gap in pertinent literature prompted us to identify the prevalence of ICAD-related stroke and describe its demographic, clinical, and radiologic characteristics in patients presenting to our center.…”

Xerostomia, Salivary Flow, and Oral Health Status Among Saudi Diabetic Patients: A Comparative Cross-Sectional Study

“…Diabetes mellitus is a metabolic disorder that negatively affects the function of different organs, including the salivary glands. 7 , 9 , 31 Alterations in the salivary glands can result in a decrease in saliva, which leads to devastating consequences, such as increased susceptibility to dental caries and periodontal diseases. The present study revealed a significantly lower salivary flow in diabetic patients compared to healthy controls (we can consider that the mixtures of both types of diabetes inflated these differences).…”