Diabetes As an Independent Risk Factor for Stroke Recurrence in Ischemic Stroke Patients: An Updated Meta-Analysis

Zhang, Li; Li, Xianqi; Wolfe, Charles D A; O’Connell, Matthew; Wang, Yanzhong

doi:10.1159/000519327

Cited by 36 publications

(30 citation statements)

References 43 publications

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“…10 Moreover, the likelihood of stroke recurrence is greater for individuals with diabetes than those without diabetes. 8 A meta-analysis demonstrated a significantly higher risk of stroke recurrence in individuals with previous ischemic stroke with diabetes than in those without diabetes (hazard ratio [HR]: 1.50; 95% confidence interval [CI]: 1.36-1.65). 8 To assess the risk of stroke associated with diabetes, a search of MEDLINE (via PubMed) was performed using the terms 'stroke' (title) AND 'diabetes' (title) AND 'risk' (text word), retrieving only citations limited to English language, human studies, and publication dates between 2010 and 2022 (n=223).…”

Section: Diabetes As a Risk Factor For Strokementioning

confidence: 99%

“…8 A meta-analysis demonstrated a significantly higher risk of stroke recurrence in individuals with previous ischemic stroke with diabetes than in those without diabetes (hazard ratio [HR]: 1.50; 95% confidence interval [CI]: 1.36-1.65). 8 To assess the risk of stroke associated with diabetes, a search of MEDLINE (via PubMed) was performed using the terms 'stroke' (title) AND 'diabetes' (title) AND 'risk' (text word), retrieving only citations limited to English language, human studies, and publication dates between 2010 and 2022 (n=223). Search results were screened based on titles and abstracts, and only those that reported risks of stroke in patients with diabetes compared with those without diabetes (sample size >1,000) were included.…”

Section: Diabetes As a Risk Factor For Strokementioning

confidence: 99%

“…Most, though not all, studies have shown that people with stroke and diabetes have worse post-stroke outcomes compared with those with stroke but without diabetes. [6][7][8][9][10][11][47][48][49] Postdischarge mortality rates are higher in individuals with ischemic stroke and diabetes versus those without diabetes. 6,10,47,48 In ad- 6 http://j-stroke.org dition, median survival is lower in people with either type of stroke (i.e., ischemic or hemorrhagic) and diabetes compared with those without diabetes.…”

Section: Post-stroke Outcomes In People With Diabetesmentioning

confidence: 99%

“…6 Furthermore, a meta-analysis exploring the effect of diabetes on stroke recurrence among individuals with ischemic stroke showed that the risk of stroke recurrence was significantly higher in those with diabetes versus those without diabetes (HR: 1.50; 95% CI: 1.36-1.65). 8 However, it is noteworthy that there is no association between HbA1c level over time and risk of stroke recurrence. 50 There is also evidence that diabetes is associated with poorer cognitive performance after stroke compared with those without diabetes.…”

Section: Post-stroke Outcomes In People With Diabetesmentioning

confidence: 99%

“…5 In addition, patients with diabetes have worse post-stroke outcomes and a greater risk for stroke recurrence as compared with those without diabetes. [6][7][8][9][10][11] 2 http://j-stroke.org…”

Section: Introductionmentioning

confidence: 99%

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Diabetes and Stroke: What Are the Connections?

et al. 2023

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Stroke is a major cause of death and long-term disability worldwide. Diabetes is associated with an increased risk of cardiovascular complications, including stroke. People with diabetes have a 1.5-2 times higher risk of stroke compared with people without diabetes, with risk increasing with diabetes duration. These risks may also differ according to sex, with a greater risk observed among women versus men. Several mechanisms associated with diabetes lead to stroke, including large artery atherosclerosis, cerebral small vessel disease, and cardiac embolism. Hyperglycemia confers increased risk for worse outcomes in people presenting with acute ischemic stroke, compared with people with normal glycemia. Moreover, people with diabetes may have poorer post-stroke outcomes and higher risk of stroke recurrence than those without diabetes. Appropriate management of diabetes and other vascular risk factors may improve stroke outcomes and reduce the risk for recurrent stroke. Secondary stroke prevention guidelines recommend screening for diabetes following a stroke. The diabetes medications pioglitazone and glucagon-like peptide-1 receptor agonists have demonstrated protection against stroke in randomized controlled trials; this protective effect is believed to be independent of glycemic control. Neurologists are often involved in the management of modifiable risk factors for stroke (including hypertension, hyperlipidemia, and atrial fibrillation), but less often in the direct management of diabetes. This review provides an overview of the relationships between diabetes and stroke, including epidemiology, pathophysiology, post-stroke outcomes, and treatments for people with stroke and diabetes. This should aid neurologists in diabetes-related decision-making when treating people with acute or recurrent stroke.

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Section: Diabetes As a Risk Factor For Strokementioning

confidence: 99%

Section: Diabetes As a Risk Factor For Strokementioning

confidence: 99%

Section: Post-stroke Outcomes In People With Diabetesmentioning

confidence: 99%

Section: Post-stroke Outcomes In People With Diabetesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diabetes and Stroke: What Are the Connections?

et al. 2023

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Associations between diagnosis with stroke, comorbidities, and activity of daily living among older adults in the United States

Ruksakulpiwat

Zhou

Phianhasin

et al. 2023

Chronic Diseases and Translational Medicine

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Background: Stroke is the leading cause of mortality. This study aimed to investigate the association between stroke, comorbidities, and activity of daily living (ADL) among older adults in the United States. Methods: Participants were 1165 older adults aged 60 and older from two waves (2016 and 2018) of the Health and Retirement Study who had a stroke. Descriptive statistics were used to describe demographic information and comorbidities. Logistic regressions and multiple regression analyses were used to determine associations between stroke, comorbidities, and ADL. Results: The mean age was 75.32 ± 9.5 years, and 55.6% were female. An adjusted analysis shows that older stroke adults living with diabetes as comorbidity are significantly associated with difficulty in dressing, walking, bedding, and toileting. Moreover, depression was significantly associated with difficulty in dressing, walking, bathing, eating, and bedding. At the same time, heart conditions and hypertension as comorbidity were rarely associated with difficulty in ADL. After adjusting for age and sex, heart condition and depression are significantly associated with seeing a doctor for stroke (odds ratio [OR]: 0.66; 95% confidence interval [CI]: 0.49-0.91; p = 0.01) and stroke therapy (OR: 0.46; 95% CI: 0.25-0.84; p = 0.01). Finally, stroke problem (unstandardized β [B] = 0.58, p = 0.017) and stroke therapy (B = 1.42, p < 0.001) significantly predict a lower level of independence. Conclusion: This study could benefit healthcare professionals in developing further interventions to improve older stroke adults' lives, especially those with a high level of dependence.

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