Glycaemic control and excess risk of ischaemic and haemorrhagic stroke in patients with type 1 diabetes: a cohort study of 33 453 patients

Stahl, Christina; Lind, Marcus; Svensson, Ann‐Marie; Guðbjörnsdóttir, Soffia; Mårtensson, Annica; Rosengren, Annika

doi:10.1111/joim.12572

Cited by 23 publications

(12 citation statements)

References 26 publications

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“…Even though the event rate was much smaller for haemorrhagic stroke than ischaemic stroke, the association between glycaemic control and stroke types reflected each other, demonstrating the importance of glycaemic control regardless of stroke type. 24 Our finding confirms a recent large population-based cohort study from Israel, where people with diabetes had a significantly higher risk of haemorrhagic stroke compared to the general population, which was mostly driven by glycaemic exposure and diabetes duration. 25 Interestingly, a J-shaped relationship between HbA1c and haemorrhagic stroke was observed in the same study, suggesting an association between extreme intensive glycaemic control and the risk of haemorrhagic stroke.…”

Section: Discussionsupporting

confidence: 90%

“…Our well‐powered study, including many stroke events, allowed us to investigate different types of stroke. Even though the event rate was much smaller for haemorrhagic stroke than ischaemic stroke, the association between glycaemic control and stroke types reflected each other, demonstrating the importance of glycaemic control regardless of stroke type . Our finding confirms a recent large population‐based cohort study from Israel, where people with diabetes had a significantly higher risk of haemorrhagic stroke compared to the general population, which was mostly driven by glycaemic exposure and diabetes duration .…”

Section: Discussionsupporting

confidence: 82%

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Risk of first stroke in people with type 2 diabetes and its relation to glycaemic control: A nationwide observational study

Zabala

Darsalia

Holzmann

et al. 2019

Diabetes Obesity Metabolism

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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.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 82%

Risk of first stroke in people with type 2 diabetes and its relation to glycaemic control: A nationwide observational study

Zabala

Darsalia

Holzmann

et al. 2019

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…8,17 The association between DN and CVD has mostly been studied in terms of mortality 1,9,18 or absolute morbidity 10 recent Swedish study assessed the excess risk related to CHD 6 and stroke. 19 Similarly, as in the present study, the HR for CHD was much higher in women than in men and was the highest in the women with ESRD (HR = 32), but it was considerably lower than that in the present study (SIR = 113). It is notable that the overall proportion of participants with CHD was much lower at 2.2%, compared with 12.4% in the present study, although the populations were of similar age.…”

Section: Discussionsupporting

confidence: 79%

Risk of coronary artery disease and stroke according to sex and presence of diabetic nephropathy in type 1 diabetes

Harjutsalo

Thomas

Forsblom

et al. 2018

Diabetes Obesity Metabolism

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“…14 Mind az ischaemiás, mind a vérzéses stroke kockázata szorosan összefügg a glykaemiás állapottal, és a HbA 1c emelkedésével növekszik. 15 Az elérni kívánt HbA 1c -célérték T1DM-ben is individuális, de általánosan elmondható, hogy törekedni kell a 7% alatti értékre. 16 Itt hívjuk fel a figyelmet arra, hogy bizonyított a hypoglykaemia és a CV kockázat összefüggése is.…”

Section: Kardiovaszkuláris Rizikócsökkentés 1-es Típusú Diabetes Mellunclassified

“…Ha nem volt CV esemény és a T1DM-es beteg kevesebb mint 20 éves betegségtartammal 40 év alatti vagy elmúlt 75 éves, akkor egyéni mérlegelés alapján, az egyéb CV kockázati tényezőktől függően a statinkezelés elkezdése javasolt LDL-koleszterin 3,36-4,1 mmol/l közötti értéknél, a célérték: LDLkoleszterin ≤2,6 mmol/l (magyar ajánlás <2,5 mmol/l). 15 Itt jegyezzük meg, hogy az ADA már gyermekkorban, 10 éves életkor felett is statinkezelést javasol, ha az életmódi terápia ellenére az LDL-koleszterin >4,1 mmol/l vagy ha >3,4 mmol/l és egyéb CV rizikó is jelen van. Ebben az esetben is a célérték: LDL-koleszterin ≤2,6 mmol/l.…”

Section: Vérnyomásunclassified

A kardiovaszkuláris kockázat csökkentése 1-es típusú diabetes mellitusban, felnőttkorban

Hosszúfalusi¹,

Kempler²

2019

Diabetologia Hungarica

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A kardiovaszkuláris kockázat csökkentése 1-es típusú diabetes mellitusban, felnőttkorbanHosszúfalusi Nóra dr., Kempler Miklós dr. ÖsszefoglalásAz elmúlt évtizedekben jelentősen javult -svéd adatok szerint 29%-kal csökkent -a mortalitás 1-es típusú diabetes mellitusban (T1DM). Ennek ellenére a halálozás még mindig 2-8-szoros az átlagnépesség adataihoz képest: ez 20 éves életkorban körülbelül 12 évvel csökkenti a várható élettartamot. Új megfigyelés, hogy minél hamarabb kezdődik a T1DM, annál nagyobb a halálozási kockázat, függetlenül a betegségtartamtól. A vezető halálok a kardiovaszkuláris halálozás. A korai, komplex kardiovaszkuláris rizikócsökkentés fontos aspektusa az 1-es típusú cukorbetegek gondozásának. Ennek összetevői a jó glykaemiás állapot a hypoglykaemia lehető legritkább előfordulása mellett, egészséges életmód, rendszeres mozgás, az elhízás és a dohányzás elkerülése, valamint az egyéb, gyógyszerrel is befolyásolható rizikótényezők (vérnyomás, LDL-koleszterin, albuminuria) célértékre történő kezelése, esetleg aszpirinterápia primer prevencióként. A szerzők a nemzetközi és hazai ajánlások alapján foglalják össze a kardiovaszkuláris prevenció lehetőségeit 1-es típusú diabetes mellitusban, hangsúlyozva a fiatalkori kockázatcsökkentés fontosságát. ■ Kulcsszavak: 1-es típusú diabetes mellitus, T1DM, halálozás, kardiovaszkuláris halálozás, kardiovaszkuláris rizikó Cardiovascular risk reduction in type 1 diabetes mellitus in adultsSummary: In the past decades, the mortality of type 1 diabetes mellitus (T1DM) has greatly improved, according to the Swedish database the mortality decreased with 29%. Still there is 2-8-fold higher mortality rate in T1DM compared to the general population, causing an average of 12-year lower life expectancy in a 20-year-old individual. Recent studies suggest that earlier start of the disease is associated with higher mortality risk regardless of disease duration. The leading cause of death is cardiovascular mortality. Early complex cardiovascular risk reduction is an important aspect of the management of patient with T1DM. Its components are the good glycaemic control at the lowest possible incidence of hypoglycaemia, healthy lifestyle, regular exercise, avoidance of obesity and smoking, as well as treating other medically manageable risk factors (such as blood pressure, LDL-cholesterol and albuminuria) to target values. We summarize the available options of cardiovascular prevention in type 1 diabetes mellitus based on national and international guidelines and emphasize the importance of risk reduction among the young patients with T1DM.

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Glycaemic control and excess risk of ischaemic and haemorrhagic stroke in patients with type 1 diabetes: a cohort study of 33 453 patients

Cited by 23 publications

References 26 publications

Risk of first stroke in people with type 2 diabetes and its relation to glycaemic control: A nationwide observational study

Risk of first stroke in people with type 2 diabetes and its relation to glycaemic control: A nationwide observational study

Risk of coronary artery disease and stroke according to sex and presence of diabetic nephropathy in type 1 diabetes

A kardiovaszkuláris kockázat csökkentése 1-es típusú diabetes mellitusban, felnőttkorban

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