Abstract
Objective To explore the associations between type 2 diabetes mellitus (DM) and stroke by evaluating the clinical risk factors, characteristics, and outcomes of acute ischemic stroke (AIS) patients with and without type 2 DM. Methods A total of 1,156 AIS patients (including 410 with type 2 DM (AIS-DM group)) and 746 without type 2 DM (AIS-NDM group)) were included. Patients' demographics, auxiliary examinations, clinical manifestations, and treatment outcomes were recorded and analyzed. Results Among the included AIS patients, 35.46% had type 2 DM. The AIS-DM group had less males (59.76% versus 70.64%), less smokers (33.90% versus 41.96%), more patients with hypertension (72.93% versus 63.94%; p=0.002), higher triglyceride levels (42.93% versus 25.08%; p ≤ 0.01), and lower total cholesterol (147.06 mg/dl versus 175.31 mg/dl) than the AIS-NDM group. The proportion of patients with large artery atherosclerosis (LAA) in the AIS-DM group was lower (77.56% versus 85.92%; p < 0.05) than that in the AIS-NDM group, and the proportion of patients with small arterial occlusions (SAO) in the AIS-DM group was higher (27.07% versus 13.67%; p < 0.05) than that in the AIS-NDM group. The mean National Institutes of Health Stroke Scale (NIHSS) score at admission in the AIS-DM group was lower than that in the AIS-NDM group (4.39 versus 5.00; p=0.008), but there was no significant difference in the NIHSS score or the modified Rankin Scale score between the two groups at discharge. A total of 85 AIS patients underwent intravenous thrombolysis treatment with recombinant tissue plasminogen activator (rtPA). The door-to-needle time (DNT) did not differ significantly between the groups (49.39 ± 30.40 min versus 44.25 ± 15.24 min; p=0.433). In addition, there were no significant differences in the baseline NIHSS score, 7-day NIHSS score, and mRS score at discharge between the groups. After intravenous thrombolysis with rtPA, the AIS-NDM group had better recovery (44.30% versus 29.20%; p=0.017) and a higher ratio of good treatment outcome at discharge (65.60% versus 54.20%; p=0.762). Conclusions Type 2 DM is associated with AIS and its risk factors, such as dyslipidemia and hypertension. Patients in the AIS-DM group had less LAA and smaller arterial occlusions, and DM could exacerbate the short-term clinical outcomes in AIS patients.
Highlights
Diabetes mellitus (DM) is a common chronic metabolic disorder characterized by a high blood glucose level, which has prevalence of 8.8% in the general population worldwide [1]
If the patient reported that they had type 2 DM but had not used hypoglycemic medication or the patient did not know whether they had type 2 DM or not, the diagnosis was made based on the following criteria: (1) glycated hemoglobin (HbA1c) ≥6.5%, (2) fasting plasma glucose (FPG) ≥126 mg/dL, (3) 2-hour blood glucose ≥200 mg/dL on oral glucose tolerance test, or (4) random blood glucose (RPG) ≥200 mg/dL with typical symptoms of hyperglycemia or hyperglycemic crisis [21]
A total of 1,156 Acute ischemic stroke (AIS) patients including 410 patients (35.46%) with type 2 DM (AIS-DM group) and 746 patients (64.53%) without type 2 DM (AIS-NDM group) were enrolled in this study. e risk factors of both groups were compared, and several differences were observed (Table 1). e AIS-DM group had fewer males (59.76% versus 70.64%) and fewer smokers (33.90% versus 41.96%). ere was no significant difference in those who received ≥1 lipid-lowering drug for ≥3 months before admission between the AIS-DM group and AIS-NDM group (14.88% versus 17.96%; p 0.190)
Summary
Diabetes mellitus (DM) is a common chronic metabolic disorder characterized by a high blood glucose level, which has prevalence of 8.8% in the general population worldwide [1]. Hyperglycemia might be associated with poorer clinical outcomes (e.g., recurrence and higher disability or mortality) in ischemic and hemorrhagic stroke [16]. Recent studies showed that approximately 30% of AIS patients had DM, which could cause poorer clinical outcomes compared with those experienced by AIS patients without DM [17]. Southern China is an economically developed region of China and has a higher incidence of type 2 DM [5]. Compared with other regions, southern China has the lowest incidence of stroke [19]. Ere are no reports on the clinical characteristics and prognosis of AIS in patients with DM in southern China, to the best of the authors’ knowledge. E clinical features and prognosis of AIS between patients with and without DM in this region are compared The correlation between AIS and type 2 DM is investigated in southern China by conducting a retrospective analysis. e clinical features and prognosis of AIS between patients with and without DM in this region are compared
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