Aims
To compare stroke incidence in people with type 2 diabetes (T2D) with that in a matched control group, and to investigate whether glucose exposure in people with T2D can predict a first‐time stroke event and mortality.
Material and methods
In a nationwide observational cohort study, individuals with T2D were linked in the Swedish National Diabetes Register and matched with five individual population‐based control subjects. We calculated crude incidence rates and 95% confidence intervals (CIs), and used Cox regression and multivariable hazard ratios (HRs), to estimate the risk of stroke and mortality in relation to glycated haemoglobin (HbA1c) levels.
Results
A total of 406 271 people with T2D (age 64.1 ± 12.4 years, 45.7% women) and 2086 440 control subjects (age 64.0 ± 12.4 years, 45.7% women) were included. During a median follow‐up of 7.3 years, 26 380 people with T2D (6.5%) versus 92 375 control subjects (4.4%) were diagnosed with a stroke. The incidence rate was 10.12 events per 1000 person‐years versus 7.26 events per 1000 person‐years (HR 1.54, 95% CI 1.52‐1.56). In the T2D group after multivariable adjustments, the HRs for stroke stratified by HbA1c level were: 54‐64 mmol/mol: 1.27 (95% CI 1.22‐1.32); 65‐75 mmol/mol: 1.68 (95% CI 1.60‐1.76); 76‐86 mmol/mol: 1.89 (95% CI, 1.75‐2.05); and > 87 mmol/mol: 2.14 (95% CI 1.90‐2.42), respectively, compared with the reference category of HbA1c ≤53 mmol/mol. There was a stepwise increased risk of death after stroke, for every 10‐mmol/mol categorical increment of HbA1c (HR 1.71; 95% CI 1.47‐2.00) for the highest HbA1c category.
Conclusions
An increased risk of stroke and death was associated with poor glycaemic control in people with T2D.