Interaction of Sex and Diabetes on Outcome After Ischemic Stroke

Soriano-Reixach, María Montserrat; Vivanco-Hidalgo, Rosa María; Ois, Ángel; Rodríguez-Campello, Ana; Roquer, Jaume

doi:10.3389/fneur.2018.00250

Cited by 19 publications

(16 citation statements)

References 39 publications

(43 reference statements)

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“…In some cohorts with acute stroke from any cause, diabetes was associated with mortality only in men 29–31. In our study, however, a modifying effect of sex was observed only for prediction of short-term mortality after ICH: pre-diabetes was prognostic in women only and diabetes in men only.…”

Section: Discussioncontrasting

confidence: 83%

Association of prestroke glycemic status with stroke mortality

Forti

Maioli

Nativio

et al. 2020

BMJ Open Diab Res Care

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ObjectiveThe role of diabetes as a predictor of mortality after stroke remains uncertain, and there are very few data for pre-diabetes. This study investigated the association of pre-diabetes and diabetes with 30-day and 1-year mortality after ischemic stroke (IS) and primary intracerebral hemorrhage (ICH).Research design and methodsBetween 2006 and 2013, 2076 patients with IS and 586 patients with ICH (median age 79) were admitted to hospital within 24 hours after stroke onset and were treated in a stroke unit, where they underwent measurement of glycated hemoglobin (HbA1c). Diabetes was retrospectively defined based on medical history, diagnosis during hospital stay or HbA1c ≥6.5% (48 mmol/mol). Pre-diabetes was defined as HbA1c of 5.7%–6.4% (39–47 mmol/mol). Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS). HRs were used to test the association of pre-diabetes and diabetes with 30-day and 1-year mortality after stroke onset.ResultsAmong patients with IS, 830 had pre-diabetes and 632 had diabetes; 280 died within 30 days and the other 77 within 1 year. Among patients with ICH, 106 had pre-diabetes and 56 had diabetes; 150 died within 30 days and the other 92 within 1 year. In both stroke subtypes, pre-diabetes and diabetes were associated with higher 30-day mortality. In IS, however, the association was limited to patients with prestroke disability and very severe stroke. At NIHSS 25, HR was 1.58 (95% CI 1.07 to 2.35) for pre-diabetes and 1.67 (95% CI 1.14 to 2.46) for diabetes compared with normoglycemia. In ICH, the association was limited to women for pre-diabetes (HR 1.93, 95% CI 1.15 to 3.24) and to men for diabetes (HR 1.78, 95% CI 1.02 to 3.12). Prestroke glycemic status was unrelated to 1-year mortality.ConclusionsBoth pre-diabetes and diabetes predict short-term mortality after acute stroke, but the association varies depending on both prestroke and stroke-related characteristics. These findings may explain the heterogeneous results obtained by previous studies.

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Section: Discussioncontrasting

confidence: 83%

Association of prestroke glycemic status with stroke mortality

Forti

Maioli

Nativio

et al. 2020

BMJ Open Diab Res Care

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“…Furthermore, T2DM men had higher incidence rates of ischemic stroke than T2DM women. These trends are in accordance with what had been previously described in diabetic population [ 10 , 21 ]. Despite the American Heart Association/American Stroke Association having summarized the particularities of ischemic stroke in women, in part due to the increasing rates stroke mortality in women [ 22 ], virtually every study shows persistently higher ischemic stroke incidence rates in men.…”

Section: Discussionsupporting

confidence: 93%

“…Sex differences may be related to the incidence and outcomes of ischemic stroke among persons with diabetes [ 9 , 10 , 11 ]. Peters et al [ 9 ] concluded that diabetes had a greater impact in the risk of stroke among women than men (27% excess risk), independently of other stroke risk factors.…”

Section: Introductionmentioning

confidence: 99%

Sex-Related Disparities in the Incidence and Outcomes of Ischemic Stroke among Type 2 Diabetes Patients. A Matched-Pair Analysis Using the Spanish National Hospital Discharge Database for Years 2016–2018

López‐de‐Andrés

Jiménez‐García

Hernández‐Barrera

et al. 2021

IJERPH

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Background: To analyze the incidence, use of therapeutic procedures, and in-hospital outcomes among patients suffering an ischemic stroke (IS) according to the presence of type 2 diabetes mellitus (T2DM) in Spain (2016–2018) and to assess the existence of sex differences. Methods: Matched-pair analysis using the Spanish National Hospital discharge. Results: IS was coded in 92,524 men and 79,731 women (29.53% with T2DM). The adjusted incidence of IS (IRR 2.02; 95% CI 1.99–2.04) was higher in T2DM than non-T2DM subjects, with higher IRRs in both sexes. Men with T2DM had a higher incidence of IS than T2DM women (IRR 1.54; 95% CI 1.51–1.57). After matching patients with T2DM, those with other comorbid conditions, however, significantly less frequently received endovascular thrombectomy and thrombolytic therapy. In-hospital mortality (IHM) was lower among T2DM men than matched non-T2DM men (8.23% vs. 8.71%; p < 0.001). Women with T2DM had a higher IHM rate than T2DM men (11.5% vs. 10.20%; p = 0.004). After adjusting for confounders, women with T2DM had a 12% higher mortality risk than T2DM men (OR 1.12; 95% CI 1.04–1.21). Conclusions: T2DM is associated with higher incidence of IS in both sexes. Men with T2DM have a higher incidence rates of IS than T2DM women. Women with T2DM have a higher risk of dying in the hospital.

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“…Nevertheless, women with diabetes had a higher risk of AKI than men. Previous studies have yielded equivocal results regarding the interaction between sex and diabetes mellitus in stroke outcomes, which could be due to ethnic differences between populations [21][22][23]. More research is needed to clearly establish the relationship between diabetes, sex and stroke outcomes in different populations.…”

Section: Discussionmentioning

confidence: 99%

Impact of Diabetes on Complications, Long Term Mortality and Recurrence in 608,890 Hospitalised Patients with Stroke

Szlachetka

Pana

Tiamkao

et al. 2020

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Background: Patients with diabetes mellitus (DM) have been found to be at an increased risk of suffering a stroke. However, research on the impact of DM on stroke outcomes is limited. Objectives: We aimed to examine the influence of DM on outcomes in ischaemic (IS) and haemorrhagic stroke (HS) patients. Methods: We included 608,890 consecutive stroke patients from the Thailand national insurance registry. In-hospital mortality, sepsis, pneumonia, acute kidney injury (AKI), urinary tract infection (UTI) and cardiovascular events were evaluated using logistic regressions. Long-term analysis was performed on first-stroke patients with a determined pathology (n = 398,663) using Royston-Parmar models. Median follow-ups were 4.21 and 4.78 years for IS and HS, respectively. All analyses were stratified by stroke sub-type. Results: Mean age (SD) was 64.3 (13.7) years, 44.9% were female with 61% IS, 28% HS and 11% undetermined strokes. DM was associated with in-hospital death, pneumonia, sepsis, AKI and cardiovascular events (odds ratios ranging from 1.13-1.78, p < 0.01) in both stroke types. In IS, DM was associated with long-term mortality and recurrence throughout the follow-up: HR max (99% CI) at t = 4108 days: 1.54 (1.27, 1.86) and HR (99% CI) = 1.27(1.23,1.32), respectively. In HS, HR max (t = 4108 days) for long-term mortality was 2.10 (1.87, 2.37), significant after day 14 post-discharge. HR max (t = 455) for long-term recurrence of HS was 1.29 (1.09, 1.53), significant after day 116 post-discharge. Conclusions: Regardless of stroke type, DM was associated with in-hospital death and complications, long-term mortality and stroke recurrence.

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Interaction of Sex and Diabetes on Outcome After Ischemic Stroke

Cited by 19 publications

References 39 publications

Association of prestroke glycemic status with stroke mortality

Association of prestroke glycemic status with stroke mortality

Sex-Related Disparities in the Incidence and Outcomes of Ischemic Stroke among Type 2 Diabetes Patients. A Matched-Pair Analysis Using the Spanish National Hospital Discharge Database for Years 2016–2018

Impact of Diabetes on Complications, Long Term Mortality and Recurrence in 608,890 Hospitalised Patients with Stroke

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