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30-05-2011 | Stroke | Article

Long-term outcomes poor after diabetic stroke

Abstract

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MedWire News: Patients with diabetes, particularly those with Type 1 diabetes, have a poor long-term prognosis after stroke, report Finnish researchers.

Their study found that patients with Type 1 diabetes have about a four-fold increase in recurrent stroke risk and a 10-fold increased risk for vascular events, including stroke and myocardial infarction (MI), relative to nondiabetic patients.

They were also about twice as likely to die during follow-up, which averaged 9 years.

"The present findings of the very high long-term risk for vascular events in patients both with Type 1 diabetes and with Type 2 diabetes are startling, primarily because of our cohort's young age," say Jukka Putaala (Helsinki University Central Hospital) and team.

The 1008 patients in the study were aged between 15 and 49 years - in their early 40s, on average.

The cumulative 10-year rate of recurrent ischemic stroke was 40.9% among the 44 patients with Type 1 diabetes and 29.7% among the 60 with Type 2 diabetes, compared with 12.0% among the 900 nondiabetic patients.

Vascular events, comprising any stroke, MI, revascularization, or vascular death, occurred in 65.1% and 46.9% of patients with Type 1 and Type 2 diabetes, respectively, versus 19.3% of nondiabetic patients.

The presence of diabetes did not affect initial stroke severity, based on National Institutes of Health Stroke Scale scores.

"The severity of the initial neurologic deficits cannot thus contribute to the more than two-fold higher long-term mortality experienced by our diabetic compared with nondiabetic patients," Putaala et al write in the journal Neurology.

Stroke etiology did differ between the groups, however, with small-vessel disease accounting for 61.4% and 41.7% of strokes among patients with Type 1 and Type 2 diabetes, respectively, compared with just 9.6% of strokes in nondiabetic patients.

Recent research showed that patients with small-vessel disease stroke have poor long-term outcomes relative to those with other stroke etiologies, independent of confounders.

The team believes that small-vessel strokes in Type 1 diabetes patients are partly caused by the long-term effect of hyperglycemia on small arterioles, so are "likely a manifestation of extended diffuse arteriopathy of the small perforating arteries… resulting in multiple lacunar infarcts and leukoaraiosis."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Eleanor McDermid

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