Abstract
ObjectiveSeveral controversial findings have been reported on treatment outcomes for diabetic stroke patients that received thrombolysis therapy in the hospital. We determined whether the association between telestroke technology, thrombolysis therapy and clinical risk factors in diabetic acute ischemic stroke may result in the inclusion or exclusion or more diabetic ischemic stroke patients for thrombolysis therapy.MethodsRetrospective data that comprises of a total of 3202 acute ischemic stroke patients from a regional stroke registry that contained telestroke and non telestroke patients with a primary diagnosis of acute ischemic stroke of which 312 were identified as diabetic stroke patients were used in this study. Multivariate logistic regression models were used to determine the associated pre-clinical risk factors, and demographics associated with recombinant tissue plasminogen activator (rtPA) therapy in a subset of diabetic acute ischemic stroke patients in the telestroke and non-telestroke settings.ResultsIn the telestroke, only higher International Normalized Ratio (INR) [odds ratio, OR = 0.063 (0.003–1.347, 95% confidence interval (CI)] was associated with exclusion from thrombolysis. Direct admission [OR, 3.141 (1–9.867), 95% CI] and telestroke [OR, 4.87 (1.834–12.928), 95% CI] were independent predictors in the inclusion for thrombolysis therapy. In the non telestroke, older age (> 80 years) [(OR), 0.955 (0.922–0.989), 95% CI], higher blood glucose level [OR, 0.994 (0.99–0.999); 95% CI], higher INR [OR, 0.113 (0.014–0.944); 95% CI], and renal insufficiency [OR, 0.163 (0.033–0.791); 95% CI] were associated with exclusion while higher NIH stroke scale [OR, 1.068 (1.009–1.13); 95% CI] was associated with inclusion for thrombolysis in the non telestroke.ConclusionThe non-telestroke setting admitted more diabetic stroke patients to the hospital, but more were excluded from thrombolysis therapy when compared with the telestroke setting. Measures to improve clinical risk factors that excluded more diabetic ischemic stroke patients in the non telestroke will improve the use of thrombolysis in the treatment of diabetic acute ischemic stroke patients.
Highlights
Diabetes mellitus is a frequently identified comorbid risk factor in acute ischemic stroke
We investigated this issue in a population of diabetic acute ischemic stroke patients treated in a telestroke and compared our findings with a non telestroke setting
Telestroke patients tended to be younger (65.9 ± 12.3 vs. 69.3 ± 12.7), have a higher body mass index (32.2 ± 7.5 vs. 29.5 ± 7.3), less likely to have a history of atrial fibrillation (8.3% vs. 21.7%), or a previous stroke (23.5% vs. 40.6%), more likely to have a family history of stroke (18.2% vs. 7.8%) and obese (64.4% vs. 43.3%)
Summary
Diabetes mellitus is a frequently identified comorbid risk factor in acute ischemic stroke. The risk of ischemic stroke in diabetic patients is twofold higher when compared to people without diabetes [1] This underlies the close relationship between these two co-occurring common diseases. Though the disease processes are closely related, controversial findings have been reported on treatment outcomes for diabetic stroke patients that received thrombolysis therapy [2,3,4,5,6]. This is because the management of diabetic stroke patients is complicated, and this results in most of the observed controversial outcomes.
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