Following acute stroke/TIA, patients with comorbid diabetes have poor outcomes even if they receive best-practice treatment, Australian research shows.
According to an Australian Stroke Clinical Registry study of more than 14,000 patients with IS/ICH or TIA admitted to 39 hospitals across four states in 2009-2013, 22% also had diabetes.
Patients with diabetes were more often male, younger, in lower socioeconomic quintiles, unable to walk on admission, and had greater prevalence of hypertension, dyslipidaemia, obesity, CVD, or kidney disease.
The study found relatively good adherence to indicators of best-practice management of acute stroke/ TIA regardless of diabetes.
Patients with and without diabetes were equally likely to receive stroke unit care, but those with diabetes were more often discharged on antihypertensive agents (79% vs. 68%) or with a care plan (50% vs. 47%).
Patients with diabetes were less often discharged home from acute care than those with diabetes for both the IS/ICH (38% vs. 44%) and TIA cohorts (81% vs. 87%).
Patients with TIA and diabetes were more often discharged to residential care than patients with TIA and no diabetes (7% vs. 3%).
The study, published in the Journal of Stroke and Cerebrovascular Diseases, found the presence of diabetes in patients with IS/ICH was significantly associated with all-cause mortality (HR 1.13; 95% CI 1.04-1.23).
Hospital readmissions for all causes or for CVD were also greater among patients with diabetes than those without diabetes (HR 1.18).
In patients with TIA, diabetes was associated with an approximate two-fold greater unadjusted cumulative rates for all-cause mortality and CVD mortality.
“There was a significant association of diabetes with greater incidence of readmissions for all causes (IRR 1.19, 95% CI 1.03, 1.37), with this association being significantly modified by having a history of hyperlipidaemia (p=0.018),” the study said.
The investigators said their findings on the association of diabetes with all-cause mortality and readmission at one year after IS/ICH agree with those from prior studies.
“A novel finding is the considerable difference between patients with IS/ICH and TIA in the association of diabetes with outcomes.”
“Given the little or no effect of diabetes on long-term outcomes in people with IS or ICH and/or worse risk factor profile, efforts at optimising risk reduction following a stroke or TIA complicated by diabetes may be more beneficial in patients with TIA.”