Diabetes and Long-Term Outcomes of Ischemic Stroke

Study Questions:

Do outcomes after ischemic stroke (IS) differ between patients with and without diabetes?

Methods:

Patients aged ≥65 years (n = 409,060) in Get With The Guidelines-Stroke (nationwide registry of stroke patients from 1,690 sites in the United States) were followed for 3 years post-discharge. The outcomes of interest were mortality, cardiovascular (CV) and non-CV hospitalizations, heart failure (HF), and recurrence of IS/transient ischemic attack (TIA). Diabetes was defined by prior medical history or new clinical diagnosis during the index hospitalization.

Results:

Patients with diabetes (29.6%) were younger, from an ethnic minority (Hispanic or black), had a higher body mass index, as well as comorbidities including hypertension, dyslipidemia, chronic kidney disease, prior IS/TIA, atherosclerotic CV disease (ASCVD), and HF. At 3 years post-discharge after IS, diabetes was associated with significant higher risks of adverse outcomes: all-cause mortality cumulative incidence 46.0% vs. 44.2%, all-cause readmission 71.3% vs. 63.7%, composite of mortality and CV readmission 69.5% vs. 64.3%, IS/TIA readmission 15.9% vs. 13.3%, HF readmission 10.3% vs. 6.4%, non-CV readmission 58.3% vs. 50.3%, and non-IS/TIA readmission 67.6% vs. 59.7%. Accounting for the initial severity of stroke using the National Institutes of Health Stroke Scale, as well as using propensity score matching method as a sensitivity analysis, did not modify the results.

Conclusions:

Among older IS patients, diabetes was associated with increased risks of death, CV and non-CV hospitalizations, HF, and IS/TIA recurrence.

Perspective:

Regardless of whether the worse outcome post-ischemic stroke in diabetes is or is not related to comorbidities or an independent mechanism, as the authors suggest, early detection of diabetes and protocol-driven treatments of ASCVD, as well as novel hypoglycemic agents that improve outcome need to be considered.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Hypertension

Keywords: Atherosclerosis, Body Mass Index, Brain Ischemia, Comorbidity, Diabetes Mellitus, Dyslipidemias, Geriatrics, Heart Failure, Hypertension, Hypoglycemic Agents, Ischemic Attack, Transient, Outcome Assessment (Health Care), Patient Readmission, Primary Prevention, Renal Insufficiency, Chronic, Stroke, Vascular Diseases


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