Abstract
Background: Prediabetes (preDM) is known to double the risk of strokes and also predicts poor functional outcomes. With rising prevalence of preDM among the elderly population in the US, this study aimed to analyze the risk and trends in secondary stroke in elderly with preDM. Methods: We queried the National Inpatient Sample (2016-2019) to identify secondary stroke (with prior stroke/transient ischemic attack, TIA) hospitalizations in elderly population (≥65 years) with vs. without preDM by using ICD-10 codes after excluding patients with diabetes mellitus. Trends and risk of recurrent stroke events, demographics, comorbidities, and outcomes were compared between two cohorts (preDM+ vs. preDM-). Results: Overall prevalence of secondary stroke in geriatric preDM population for 2016-2019 was 2.01% (4045/201120, 50.8% female, 68.4% white) with preDM+ cohort often consisting of younger (median 77 vs 81yrs), male vs females (49.2% vs 44.8%), blacks (14.7% vs 10.7%), Hispanics (8.9% vs 5.4%), Asian/Pacific Islanders (7.2% vs 2.6%) (p<0.001). There were declining trends in recurrent any/ischemic strokes among overall/preDM- cohort but nondeclining in preDM+ cohort Table 1a . The preDM+ cohort often had higher rates of hypertension, hyperlipidemia, obstructive sleep apnea, obesity and peripheral vascular disease. Multivariate analysis adjusted for confounders showed higher odds of any stroke (aOR:1.74, 95%CI:1.58-1.92) and ischemic strokes (aOR:1.83, 95%CI:1.64-2.03) (p<0.001) in preDM+ cohort vs. preDM- cohort [Table 1b] with prior history of stroke/TIA. The rates of transfer to short term hospitals and home health care requirements were higher among preDM+ cohort (3.2% vs. 2.9% & 18.7% vs. 17%). Conclusion: The study shows an increased risk of recurrent/secondary strokes (mainly ischemic) among elderly patients with preDM. Findings emphasize the need for strategies to achieve tighter glycemic control to mitigate risk of future cerebrovascular events.
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