Diabetes Mellitus Is Associated With Poor In‐Hospital and Long‐Term Outcomes in Young and Midlife Stroke Survivors

Background The incidence of ischemic stroke has increased among adults aged 18 to 64 years, yet little is known about relationships between specific risk factors and outcomes. This study investigates in‐hospital and long‐term outcomes in patients with stroke aged <65 years with preexisting diabetes mellitus. Methods and Results Consecutive patients aged <65 years admitted to comprehensive stroke centers for acute ischemic stroke between 2003 and 2013 were identified from the Ontario Stroke Registry. Multinomial logistic regression was used to estimate adjusted odds ratio (OR [95% CI]) of in‐hospital mortality or direct discharge to long‐term or continuing care. Cox proportional hazards regression was used to estimate the adjusted hazards ratio (aHR [95% CI]) of long‐term mortality, readmission for stroke/transient ischemic attack, admission to long‐term care, and incident dementia. Predefined sensitivity analyses examined stroke outcomes among young (aged 18–49 years) and midlife (aged 50–65 years) subgroups. Among 8293 stroke survivors (mean age, 53.6±8.9 years), preexisting diabetes mellitus was associated with a higher likelihood of in‐hospital death (adjusted OR, 1.46 [95% CI, 1.14–1.87]) or direct discharge to long‐term care (adjusted OR, 1.65 [95% CI, 1.07–2.54]). Among stroke survivors discharged (N=7847) and followed up over a median of 6.3 years, preexisting diabetes mellitus was associated with increased hazards of death (aHR, 1.68 [95% CI, 1.50–1.88]), admission to long‐term care (aHR, 1.57 [95% CI, 1.35–1.82]), readmission for stroke/transient ischemic attack (aHR, 1.37 [95% CI, 0.21–1.54]), and incident dementia (aHR, 1.44 [95% CI, 1.17–1.77]). Only incident dementia was not increased for young stroke survivors. Conclusions Focused secondary prevention and risk factor management may be needed to address poor long‐term outcomes for patients with stroke aged <65 years with preexisting diabetes mellitus.

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Depression and Diabetes Mellitus Multimorbidity Is Associated With Loss of Independence and Dementia Poststroke

Stroke ◽

10.1161/strokeaha.120.031068 ◽

2020 ◽

Vol 51 (12) ◽

pp. 3531-3540

Author(s):

Michael Ouk ◽

Che-Yuan Wu ◽

Jessica Colby-Milley ◽

Jiming Fang ◽

Limei Zhou ◽

...

Keyword(s):

Diabetes Mellitus ◽

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Long Term Care ◽

Stroke Recovery ◽

Term Care ◽

Incident Dementia ◽

All Cause Mortality ◽

Ischemic Attack

Background and Purpose: Many patients with ischemic stroke present with multiple comorbidities that threaten survival and recovery. This study sought to determine the risks of adverse long-term stroke outcomes associated with multimorbid diabetes mellitus and depression. Methods: Retrospective analysis of prospectively collected data on consecutive patients without premorbid dementia admitted from the community for a first-ever acute ischemic stroke to comprehensive stroke centers across Ontario, Canada (2003–2013). Premorbid histories of diabetes mellitus and depression were ascertained within 5 years before stroke admission. Adjusted hazard ratios (aHR [95% CI]) of admission to long-term care, incident dementia, readmission for stroke or transient ischemic attack and all-cause mortality, over time among those discharged back into the community poststroke. Results: Among 23 579 stroke admissions, n=20 201 were discharged back into the community. Diabetes mellitus and depression were associated with synergistic hazards of admission to long-term care (X 2 =5.4; P =0.02) over a median follow-up of 5.6 years. This interaction was observed among women specifically; depression multimorbidity showed particularly high hazards of admission to long-term care (aHR Depression =1.57 [1.24–1.98]) and incident dementia (aHR Depression =1.85 [1.40–2.44]) among women with diabetes mellitus. In the whole cohort, diabetes mellitus and depression were associated individually with long-term care admission (aHR Diabetes =1.20 [1.12–1.29]; aHR Depression =1.19 [1.04–1.37]), incident dementia (aHR Diabetes =1.14 [1.06–1.23]; aHR Depression =1.27 [1.08–1.49]), stroke/transient ischemic attack readmission (aHR Diabetes =1.18 [1.10–1.26]; aHR Depression =1.24 [1.07–1.42]), and all-cause mortality (aHR Diabetes =1.29 [1.23–1.36]; aHR Depression =1.16 [1.05–1.29]). Conclusions: The risks of dementia and needing long-term care in the years after surviving a stroke were particularly elevated among women when premorbid diabetes mellitus and depression occurred together. Long-term stroke recovery strategies might target high-risk patients with mood and metabolic multimorbidity.

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