Prestroke Metformin Use on the 1-Year Prognosis of Intracerebral Hemorrhage Patients with Type 2 Diabetes

Background. Although recent studies have focused on the use of metformin in treating ischemic stroke, there is little literature to support whether it can treat intracerebral hemorrhage (ICH). Therefore, this study is aimed at evaluating the possible effects of prestroke metformin (MET) on ICH patients with type 2 diabetes. Methods. From January 2010 to December 2019, all first-ever ICH patients with type 2 diabetes from our hospitals were included. All discharged patients would receive a one-time follow-up at 1 year after admission. Death, disability, and recurrence events were recorded. Results. We included 730 patients for analysis (the median age: 65 [IQR, 56-72] years and 57.7% was men). Of those patients, 281 (38.5%) had received MET before ICH (MET+), whereas 449 (61.5%) had not (MET−). MET (+) patients had a lower median baseline hematoma volume than did MET (-) patients (9.6 ml [IQR, 5.3-22.4 ml] vs. 14.7 ml [IQR, 7.9-28.6 ml]; P < 0.001 ). The inhospital mortality events were not significantly reduced in the MET (+) group compared with the MET (-) group (6.4% vs 8.9%, respectively; absolute difference, −2.5% [95% CI, −3.9% to −0.7%]; OR, 0.70 [95% CI, 0.39 to 1.27]; P = 0.22 ). The 1-year mortality events were not significantly reduced in the MET (+) group compared with the MET (-) group (14.1% vs 17.4%, respectively; absolute difference, −3.3% [95% CI, −5.1% to −1.8%]; OR, 0.73 [95% CI, 0.47 to 1.14]; P = 0.16 ). The 1-year disability events were not significantly reduced in the MET (+) group compared with the MET (-) group (28.4% vs 34.1%, respectively; absolute difference, −5.7% [95% CI, −8.2% to −3.3%]; OR, 0.77 [95% CI, 0.52 to 1.13]; P = 0.18 ). Finally, the recurrence rates in those two groups were not significantly different (MET [+] vs. MET [-]: 6.4% vs. 5.9%; absolute difference, 0.5% [95% CI, 0.2% to 1.3%]; OR, 1.08 [95% CI, 0.51 to 2.28]; P = 0.84 ). Conclusions. Pre-ICH metformin use was not associated with inhospital mortality and 1-year prognosis in diabetic ICH patients.

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Pioglitazone for primary stroke prevention in Asian patients with type 2 diabetes and cardiovascular risk factors: A retrospective study

10.21203/rs.3.rs-17243/v2 ◽

2020 ◽

Author(s):

Yi-Chih Hung ◽

Lu-Ting Chiu ◽

Hung-Yu Huang ◽

Da-Tian Bau

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Ischemic Stroke ◽

Stroke Prevention ◽

Asian Patients ◽

Type 2 Dm ◽

Subgroup Analyses ◽

New Onset

Abstract Background: Studies assessing the efficacy of pioglitazone solely for primary stroke prevention in Asian patients with type 2 diabetes mellitus (DM) and present multiple cardiovascular (CV) risk factors are rare. Thus, we aimed to assess the effect of pioglitazone on primary stroke prevention in Asian patients with type 2 DM without established CV diseases but with risk factors for CV diseases. Methods: Between 2000 and 2012, we enrolled patients aged ≥18 years, who were newly diagnosed with type 2 diabetes and had at least one of the following CV risk factors: hypertension and hyperlipidemia. Patients with a history of stroke and those using insulin or glucagon-like peptide-1 agonist for more than 3 months were excluded. Patients were divided into the pioglitazone and non-pioglitazone groups based on their receipt of pioglitazone during the follow-up period. Propensity-score matching (1:1) was used to balance the distribution of the baseline characteristics and medications. Follow-up was terminated upon ischemic stroke development, withdrawal from the insurance system, or on December 31, 2013, whichever occurred first. The overall incidence of new-onset ischemic stroke in the two groups was subsequently compared. The subgroup analyses of ischemic stroke were conducted using different baseline features. Additionally, the effect of pioglitazone exposure dose on the occurrence of ischemic stroke was evaluated. Chi-square test, Student’s t-test, competing risk regression models, Kaplan–Meier method, and log-rank test were some of the statistical tests conducted.Results: A total of 13 078 patients were included in the pioglitazone and non-pioglitazone groups. Compared with patients who did not receive pioglitazone, those administered pioglitazone had a lower risk of developing ischemic stroke (adjusted hazard ratio: 0.78; 95% confidence interval: 0.62–0.95). The subgroup analyses defined by different baseline features did not reveal significant alterations in the observed effect of pioglitazone. Moreover, a significant decreasing trend in ischemic stroke risk with an increase in pioglitazone dose (p-value for trend = 0.04) was observed.Conclusion: Pioglitazone use decreased the risk of new-onset ischemic stroke in Asian patients with type 2 DM and CV risk factors.Trial registration number: CMUH104-REC2-115-CR4

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Abstract TP200: Independent Contribution of HbA1c, Systolic Blood Pressure, and LDL Cholesterol Control to Risk of Ischemic Stroke Hospitalizations in Type 2 Diabetes

Stroke ◽

10.1161/str.44.suppl_1.atp200 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Gregory A Nichols ◽

Shreekant Parasuraman ◽

Sandra Joshua-Gotlib

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Ischemic Stroke ◽

Stroke Risk ◽

Density Lipoprotein ◽

Increased Risk ◽

Hba1c Control

Risk of ischemic stroke is approximately doubled in patients with diabetes. To reduce risk, managing diabetes includes optimizing glycemic, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) control. We studied which risk factors alone or in combination were most strongly associated with stroke hospitalizations. We identified 26,924 Kaiser Permanente Northwest members with type 2 diabetes and no known prior cardiovascular disease hospitalization. Beginning in 2002, we identified the earliest point patients had glycosolated hemoglobin (HbA1c), systolic BP (SBP), and LDL-C measurements within 6 months of each other and followed them until they died, disenrolled, or 31 December 2011. Outcome was hospitalization with primary diagnosis of ischemic stroke. Using mean HbA1c, SBP, and LDL-C between baseline and end of follow-up, we identified dichotomous categories of control of HbA1c (<7%), SBP (<130 mm Hg) and LDL-C (<100 mg/dL) and estimated the relative risk of stroke hospitalization independently associated with all combinations of risk factors controlling for age, sex, diabetes duration, comorbidities, body mass index, smoking, and pharmacotherapy. Mean (SD) age of patients was 59 (12) years; 50% were men. Over mean (SD) follow-up of 6.2 (2.8) years, 606 (2.3%) patients were hospitalized for ischemic stroke. Compared with patients with all 3 risk factors in control, patients who had no risk factors controlled or only HbA1c controlled had >2-fold increased risk of ischemic stroke. Patients who controlled both SBP and LDL-C had significantly lower risk relative to control of all 3 risk factors. In this observational study, maintaining control of SBP over 6.2 years was essential to reduction of ischemic stroke risk. Simultaneous control of LDL-C further reduced risk, but HbA1c control <7% did not mitigate stroke risk beyond SBP and LDL-C control. Further research is needed to evaluate the relationship between HbA1c control and stroke risk.

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Does Body Mass Index and Height Influence the Incident Risk of Ischemic Stroke in Newly Diagnosed Type 2 Diabetes Subjects?

Journal of Diabetes Research ◽

10.1155/2019/2591709 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Donghui Duan ◽

Hui Li ◽

Jiaying Xu ◽

Liping Wong ◽

Guodong Xu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Body Mass Index ◽

Ischemic Stroke ◽

General Population ◽

Body Mass ◽

Disease Surveillance ◽

Newly Diagnosed ◽

Disease Surveillance System

Objective. To estimate the incident risk of ischemic stroke (IS) in newly diagnosed type 2 diabetes (T2D) subjects according to different body mass index (BMI) and height categories.Methods. A total of 25,130 newly diagnosed T2D subjects were included in this study. All T2D subjects were enrolled consecutively from the Chronic Disease Surveillance System (CDSS) of Ningbo. Standardized incidence ratio (SIR) and its 95% confidence interval (95% CI) stratified by BMI categories and height quartiles were used to estimate the incident risk of IS in T2D subjects.Results. In total, 22,795 subjects completed the follow-up. Among them, 1268 newly diagnosed IS cases were identified, with 149,675 person-years. The SIRs of normal BMI (18.5–24.0 kg/m2), overweight (24.0–28.0 kg/m2), and obese (≥28.0 kg/m2) in overall subjects were 2.56 (95% CI 1.90–3.13), 2.13 (95% CI 1.90–3.13), and 1.87 (95% CI 1.29–2.43), respectively (Ptrend<0.01), comparing to the general population of Ningbo. For each 1 kg/m2increment in BMI, the SIR was 0.948 (95% CI 0.903–0.999). For height quartiles, the SIRs of male subjects in quartile 1 (<160 cm), quartile 2 (161–165 cm), quartile 3 (165–170 cm), and quartile 4 (≥171 cm) were 2.27 (95% CI 1.99–2.56), 2.01 (95% CI 1.67–2.45), 1.37 (95% CI 1.05–1.68), and 0.91 (95% CI 0.40–1.32), respectively (Ptrend<0.01). While for female subjects, the SIRs in quartile 1 (<155 cm), quartile 2 (156–160 cm), quartile 3 (161–165 cm), and quartile 4 (≥166 cm) were 3.57 (95% CI 3.11–3.49), 2.96 (95% CI 2.61–3.31), 1.94 (95% CI 1.51–2.36), and 1.71 (95% CI 0.95–2.47), respectively (Ptrend<0.01).Conclusion. Compared to the general population of Ningbo, T2D subjects had a higher incident risk of IS. Furthermore, the IS incident risk was not only higher in newly diagnosed T2D subjects with normal BMI but also lower in taller newly diagnosed T2D subjects.

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Pioglitazone for primary stroke prevention in Asian patients with type 2 diabetes and cardiovascular risk factors: A retrospective study

10.21203/rs.3.rs-17243/v1 ◽

2020 ◽

Author(s):

Yi-Chih Hung ◽

Lu-Ting Chiu ◽

Hung-Yu Huang ◽

Da-Tian Bau

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Ischemic Stroke ◽

Stroke Prevention ◽

User Group ◽

Asian Patients ◽

Type 2 Dm ◽

New Onset

Abstract Background: To date, studies assessing the efficacy of pioglitazone solely for primary stroke prevention in Asian patients with type 2 diabetes mellitus (DM) and present multiple cardiovascular (CV) risk factors are rare. Thus, we aimed to assess the effect of pioglitazone on primary stroke prevention in Asian type 2 DM patients without established CV diseases but with risk factors for CV diseases. Methods: Between 2000 and 2012, we enrolled patients aged ≥18 years who were newly diagnosed with type 2 diabetes and had at least one of the following CV risk factors: hypertension, hyperlipidemia, proteinuria, and obesity. Patients with a history of stroke and those using insulin or glucagon-like peptide-1 agonist for more than 3 months were excluded. Patients were divided into the pioglitazone user group and non-pioglitazone user group based on their receipt of pioglitazone during the follow-up period. Propensity-score matching (1:1) was used to balance the distribution of the baseline characteristics and medications. Follow-up was terminated upon ischemic stroke development, withdrawal from the insurance system, or on December 31, 2013, whichever occurred first. The overall incidence of new-onset ischemic stroke in the two groups was subsequently compared. Subgroup analyses of ischemic stroke were conducted using different baseline features. Additionally, the effect of the pioglitazone exposure dose on the occurrence of ischemic stroke was evaluated. The chi-square test, Student’s t-test, Kaplan–Meier method, and log-rank test were some of the statistical tests conducted herein.Results: A total of 6,637 patients were included in the pioglitazone and non-pioglitazone group. Compared to patients who did not receive pioglitazone, those administered pioglitazone had a lower risk of developing ischemic stroke (adjusted hazard ratio: 0.72; 95% confidence interval: 0.57–0.9). Subgroup analyses defined by different baseline features did not reveal significant alterations to the observed effect of pioglitazone. Moreover, a significant trend regarding the decrease in ischemic stroke risk and the increase in pioglitazone dose (p-value for trend=0.03) was observed.Conclusion: Pioglitazone use decreased the risk of new-onset ischemic stroke in Asian patients with type 2 DM and CV risk factors.

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Clinical Outcomes in type 2 Diabetes with in-stent Restenosis and Late/very Late Stent Thrombosis Undergoing Primary Percutaneous Coronary Intervention: A Single-center Observational Cohort Study

10.21203/rs.3.rs-107241/v1 ◽

2020 ◽

Author(s):

Xiaoxiao Zhao ◽

Jinying Zhou ◽

Yu Tan ◽

Zhaoxue Sheng ◽

Jiannan Li ◽

...

Keyword(s):

Type 2 Diabetes ◽

Ischemic Stroke ◽

Cell Count ◽

Clinical Outcomes ◽

Late Stent Thrombosis ◽

Very Late Stent Thrombosis ◽

Stent Restenosis ◽

In Stent Restenosis

Abstract BACKGROUND: This study aimed to compare differences in the risk factors and clinical outcomes of type 2 diabetes mellitus (DM) and non-DM patients with de novo lesions (DNL), definite in-stent restenosis (ISR), and late or very late stent thrombosis (LST/VLST). METHODS: A total of 4151 patients with acute coronary syndrome were screened angiographically to determine DNL, ISR, and LST/VLST. A total of 3976 patients were included in the analysis and divided into DM (n=1302) or non-DM (n=2674) group at admission. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), defined as death, myocardial infarction, revascularization, and ischemic stroke within a 1-year follow-up period. RESULTS: In the group with total white blood cell count >10 10^9/L (p=0.004), neutral granular cell count >7 10^9/L (p=0.030), neutrophil-lymphocyte ratio >1.5 (p=0.041), DNL outperformed LST/VLST lesions in terms of revascularization at a median follow-up of 698 days. Among patients with DNL, the incidences of MACEs (log-rank p=0.0002), all-cause death (log-rank p=0.00032), cardiac-related death (log-rank p=0.021), and revascularization (log-rank p=0.029) were significantly lower in the non-DM group than in the DM group. However, no difference was observed in the event rates of endpoints among patients with ISR and LST/VLST between the non-DM and DM groups. Furthermore, among DM patients, there was a critically higher cumulative incidence of revascularization (log-rank p=0.0002) in the subgroup with ISR lesions and higher rate of ischemic stroke (log-rank p=0.033) in the subgroup with LST/VLST lesions. CONCLUSION: This study found that DM patients have a higher incidence of composite clinical outcomes than non-DM patients among patients with DNL. Compared with patients with DNL, patients with ISR lesions and LST/VLST lesions had more incidence of revascularization by long-term follow up. Thus, ISR and LST/VLST lesions are critical problems after coronary stenting, especially among DM patients.

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Vitamin D Supplementation and Serum Levels of Magne-sium and Selenium in Type 2 Diabetes Mellitus Patients: Gender Dimorphic Changes

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000190 ◽

2014 ◽

Vol 84 (1-2) ◽

pp. 27-34 ◽

Cited By ~ 7

Author(s):

Nasser M. Al-Daghri ◽

Khalid M. Alkharfy ◽

Nasiruddin Khan ◽

Hanan A. Alfawaz ◽

Abdulrahman S. Al-Ajlan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Vitamin D ◽

Type 2 Diabetes Mellitus ◽

Serum Levels ◽

Vitamin D Supplementation ◽

Serum Selenium ◽

Dependent Manner

The aim of our study was to evaluate the effects of vitamin D supplementation on circulating levels of magnesium and selenium in patients with type 2 diabetes mellitus (T2DM). A total of 126 adult Saudi patients (55 men and 71 women, mean age 53.6 ± 10.7 years) with controlled T2DM were randomly recruited for the study. All subjects were given vitamin D3 tablets (2000 IU/day) for six months. Follow-up mean concentrations of serum 25-hydroxyvitamin D [25-(OH) vitamin D] significantly increased in both men (34.1 ± 12.4 to 57.8 ± 17.0 nmol/L) and women (35.7 ± 13.5 to 60.1 ± 18.5 nmol/L, p < 0.001), while levels of parathyroid hormone (PTH) decreased significantly in both men (1.6 ± 0.17 to 0.96 ± 0.10 pmol/L, p = 0.003) and women (1.6 ± 0.17 to 1.0 ± 0.14 pmol/L, p = 0.02). In addition, there was a significant increase in serum levels of selenium and magnesium in men and women (p-values < 0.001 and 0.04, respectively) after follow-up. In women, a significant correlation was observed between delta change (variables at six months-variable at baseline) of serum magnesium versus high-density lipoprotein (HDL)-cholesterol (r = 0.36, p = 0.006) and fasting glucose (r = - 0.33, p = 0.01). In men, there was a significant correlation between serum selenium and triglycerides (r = 0.32, p = 0.04). Vitamin D supplementation improves serum concentrations of magnesium and selenium in a gender-dependent manner, which in turn could affect several cardiometabolic parameters such as glucose and lipids.

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10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes

Yearbook of Medicine ◽

10.1016/s0084-3873(09)79493-3 ◽

2009 ◽

Vol 2009 ◽

pp. 527-529

Author(s):

S. Schinner

Keyword(s):

Type 2 Diabetes ◽

Glucose Control ◽

Intensive Glucose Control

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Early complications in surgery of umbilical and epigastric hernias

Perspectives in Surgery ◽

10.33699/pis.2020.99.5.207-211 ◽

2020 ◽

Vol 99 (5) ◽

pp. 207-211

Keyword(s):

Type 2 Diabetes ◽

Recurrence Rate ◽

Mesh Repair ◽

Early Complications ◽

Recurrence Rates ◽

Fascial Defect ◽

Epigastric Hernia ◽

Mesh Implantation ◽

Hernial Sac

ntroduction: Repairs of umbilical and epigastric hernias are common surgical procedures; the choice of the surgical method generally depends on the size of the hernial sac and fascial defect. Methods: Data of patients operated on for umbilical or epigastric hernias in our hospital during two years were assessed retrospectively. The study group included 264 patients; 212 had an umbilical hernia and 52 had an epigastric hernia. We assessed epidemiologic and clinical parameters and their correlation with the occurrence of early postoperative complications. We also looked for the recurrence rate, although during only a short follow-up period. Results: In the case of umbilical hernias, early complications occurred in 6.7% (11/165) after surgery with a simple suture and in 4.3% (2/47) with mesh repair, and the recurrence rates were 3% (5/165) and 21.3% (10/47), respectively. The risk of early complications was significantly higher in larger hernias. The recurrence rate increased with older age, an increased size of the hernial sac and fascial defect, and in patients with type 2 diabetes. In epigastric hernias, early complications occurred in 5.3% (1/19) after surgery with a simple suture and in 6.1% (2/33) with mesh repair. Recurrences only occurred in operations with mesh repair, in 9% (3/33). The risk of early complications was significantly higher in type 2 diabetes patients. Conclusion: Early complications were slightly more frequent in epigastric hernia repairs with mesh implantation, but this was not the case of umbilical hernias. We recommend mesh implantation in larger and borderline sized hernias to reduce the risk of recurrence.

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