Abstract
BackgroundThe association between diabetes mellitus (DM) and prognosis of minor stroke is unclear. The aim of this study is to investigate whether DM contributes to the prognosis of minor stroke or its specific subtype.MethodsAll minor ischemic stroke patients were derived from the China National Stroke Registry and classified into 5 subtypes according to the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. DM was defined as either self-reported physician diagnosis of diabetes or use of hypoglycemic medications during hospitalization or at discharge. Patients were followed up for 1 year for clinical outcomes of recurrent stroke, death and functional outcome. Poor functional outcomes were defined as a score of 2–6 for modified Rankin Score. Associations between DM and prognosis of minor stroke and its subtypes were analyzed by univariable and multivariable logistic regression.ResultsOf 4,548 patients with minor stroke, 1,230(27.0%) patients had DM, 1,038(22.8%) had poor outcomes and 570(13.0%) of 4,401 patients had recurrent stroke at 1 year. In multivariable analyses, DM were significantly associated with 1-year stroke recurrence (Odds Ratio [OR], 1.31; 95% confidence interval [CI]: 1.08–1.59) and poor outcome (OR, 1.51; 95%CI: 1.28–1.77). Among the subtypes of minor stroke, DM was only significantly associated with 1-year stroke recurrence (OR, 1.63; 95%CI: 1.07–2.50) and poor outcome (OR, 1.73; 95%CI: 1.22–2.45) in the small-artery occlusion subtype.ConclusionsDM significantly increased the risk of stroke recurrence and poor outcome in the small-artery occlusion subtype, but not in other subtypes of minor stroke.
Highlights
Minor ischemic strokes account for approximately 30% of all strokes [1,2]
diabetes mellitus (DM) were significantly associated with 1-year stroke recurrence (Odds Ratio [odds ratios (ORs)], 1.31; 95% confidence interval [confidence intervals (CI)]: 1.08–1.59) and poor outcome (OR, 1.51; 95%CI: 1.28– 1.77)
Among the subtypes of minor stroke, DM was only significantly associated with 1year stroke recurrence (OR, 1.63; 95%CI: 1.07–2.50) and poor outcome (OR, 1.73; 95%CI: 1.22–2.45) in the small-artery occlusion subtype
Summary
Minor ischemic strokes account for approximately 30% of all strokes [1,2]. the outcome of an index stroke was favorable with minor symptoms, recent studies have shown a high risk of stroke recurrence and unfavorable outcome within 90 days after the onset of the index event [3,4]. Most diabetes mellitus (DM) patients are either hyperglycemic and/or exhibit insulin resistance Both these conditions have been postulated to trigger endothelial dysfunction and atherosclerosis, which contribute to the underlying pathogenesis of stroke [6]. This might have served as rationale for previous studies that showed DM to be an independent risk factor of stroke recurrence after a general ischemic stroke [7,8,9] or TIA [10,11]. Studies on minor stroke did not apparently show DM to be an independent risk factor of recurrent ischemic events or poor outcome [2,3]. The aim of this study is to investigate whether DM contributes to the prognosis of minor stroke or its specific subtype
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