Long-term risk of stroke in type 2 diabetes patients with diabetic ketoacidosis: A population-based, propensity score-matched, longitudinal follow-up study

Diabetes Metab. 2017 Jun;43(3):223-228. doi: 10.1016/j.diabet.2016.11.003. Epub 2017 Jan 24.


Aim: To investigate the long-term risk of stroke in type 2 diabetes (T2D) patients with previous episodes of diabetic ketoacidosis (DKA).

Methods: This retrospective nationwide population-based cohort study was conducted using Taiwan's National Health Insurance database. Claims data from 2000 to 2002 were extracted for 3572 T2D patients with DKA and 7144 controls matched for age, gender, diabetes complications severity index, frequency of clinical visits and baseline comorbidities. Patients with type 1 diabetes (T1D), identified by glucagon C-peptide stimulation or glutamic acid decarboxylase (GAD) antibody blood tests and possession of a catastrophic illness certificate were excluded. All patients were tracked until a new stroke diagnosis, death or the end of 2011.

Results: Of the 3572 selected patients, 270 with DKA and 404 of the 7144 controls were diagnosed with a new stroke, giving an incidence rate ratio (IRR) of 1.56 (95% CI: 1.34-1.82; P<0.0001). DKA patients had a higher risk of ischaemic stroke than those without DKA (IRR: 1.62, 95% CI: 1.34-1.96; P<0.0001), and DKA patients with hypertension and hyperlipidaemia were at even greater risk of stroke. Also, DKA patients were at particular risk for stroke during the first half-year following DKA diagnosis. After adjusting for patient characteristics and comorbidities, these patients were 1.55 times more likely to have a stroke than those without DKA (95% CI: 1.332-1.813, P<0.0001).

Conclusion: T2D patients with previous DKA have a higher risk of stroke, especially ischaemic strokes.

Keywords: Diabetic ketoacidosis; Stroke; Type 2 diabetes.

MeSH terms

  • Adult
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / epidemiology
  • Diabetic Ketoacidosis* / complications
  • Diabetic Ketoacidosis* / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Propensity Score
  • Retrospective Studies
  • Risk Factors
  • Stroke* / complications
  • Stroke* / epidemiology
  • Taiwan / epidemiology