High prevalence of diabetes a wake up call for stroke prevention


By Mardi Chapman

6 Oct 2020

Early detection and better management of diabetes as well as improved health literacy around the long-term risks are warranted to reduce the number of patients with ischaemic stroke and TIA.

A study of 323 stroke and TIA patients admitted to the Ballarat Base Hospital in regional Victoria over two years showed 28.5% had diabetes.

Of the stroke patients with diabetes, a significant proportion (45.3%) had suboptimal glycaemic control (median HbA1c 7.4%).

Compared to patients without diabetes, there was also a statistically higher rate of dyslipidaemia in the stroke patients with diabetes (58.7%) and a higher proportion of hypertension in patients with diabetes in both the stroke (73.3%) and TIA groups (76.5%).

The study, published in the Internal Medicine Journal, said diabetes was not found to be significantly associated with any particular territory of acute infarct (p=0.800) or cause of stroke (p=0.269).

However it noted that might be related to the relatively small sample size.

Overall, almost a third of stroke patients (30.8%) had impaired renal function (eGFR <60), with a significantly higher proportion in patients with comorbid diabetes (42.7% vs 26.0%, p<0.001).

Given Ballarat Base Hospital is the main referral centre for a catchment area of approximately 48,000 km, the investigators said their data on prevalence rates of diabetes in stroke was likely a good representation of regional Australia.

“Our data also serves to highlight the importance of appropriate long-term diabetic control in the primary prevention of stroke,” they said.

“Stroke admissions present an opportunity for clinicians to identify at-risk patients, screen for abnormal glucose metabolism and implement effective secondary prevention.”

“Our data suggests that further research is required to assess the burden of DM in regional Australia so as to facilitate better primary stroke prevention strategies.”

Senior investigator and neurologist Dr Ramesh Sahathevan told the limbic that while there was room for improvement in the level of control of diabetes seen in the study, it was not too bad.

“It isn’t as if the patients who had diabetes and were coming in with strokes had horrendous blood sugars. They didn’t.”

“I don’t know whether it is really a question of better management of diabetes. I think that part of this may have to do with health literacy more than it has to do with control of the condition.”

“So, is our general public really aware of the long-term implications of diabetes?”

“I would hope to see more people are aware that there are implications to having diabetes; that those implications are not just about having numb feet or peripheral wounds that might not heal quickly; that there is definitely a risk of heart disease and stroke and that you can reduce that risk by making sure the diabetes is controlled.”

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