Thirty-six months recurrence after acute ischemic stroke among patients with comorbid type 2 diabetes: A nested case-control study

Lu Wang; Hongyun Li; Jiheng Hao; Chao Liu; Jiyue Wang; Jingjun Feng; Zheng Guo; Yulu Zheng; Yanbo Zhang; Hongxiang Li; Liyong Zhang; Haifeng Hou

doi:10.3389/fnagi.2022.999568

Thirty-six months recurrence after acute ischemic stroke among patients with comorbid type 2 diabetes: A nested case-control study

Front Aging Neurosci. 2022 Sep 30:14:999568. doi: 10.3389/fnagi.2022.999568. eCollection 2022.

Authors

Lu Wang¹, Hongyun Li¹, Jiheng Hao², Chao Liu², Jiyue Wang², Jingjun Feng², Zheng Guo³, Yulu Zheng³, Yanbo Zhang⁴, Hongxiang Li⁴, Liyong Zhang², Haifeng Hou^{1

3}

Affiliations

¹ School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China.
² Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China.
³ School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
⁴ The Second Affiliated Hospital of Shandong First Medical University, Taian, China.

Abstract

Background: Stroke patients have to face a high risk of recurrence, especially for those with comorbid T2DM, which usually lead to much more serious neurologic damage and an increased likelihood of death. This study aimed to explore determinants of stroke relapse among patients with comorbid T2DM.

Materials and methods: We conducted this case-control study nested a prospective cohort of ischemic stroke (IS) with comorbid T2DM. During 36-month follow-up, the second stroke occurred in 84 diabetic IS patients who were allocated into the case group, while 613 patients without recurrence were the controls. We collected the demographic data, behaviors and habits, therapies, and family history at baseline, and measured the variables during follow-up. LASSO and Logistic regression analyses were carried out to develop a prediction model of stroke recurrence. The receiver operator characteristic (ROC) curve was employed to evaluate the performance of the prediction model.

Results: Compared to participants without recurrence, the higher levels of pulse rate (78.29 ± 12.79 vs. 74.88 ± 10.93) and hypertension (72.6 vs. 61.2%) were recorded at baseline. Moreover, a lower level of physical activity (77.4 vs. 90.4%), as well as a higher proportion of hypoglycemic therapy (36.9 vs. 23.3%) was also observed during 36-month follow-up. Multivariate logistic regression revealed that higher pulse rate at admission (OR = 1.027, 95 %CI = 1.005-1.049), lacking physical activity (OR = 2.838, 95% CI = 1.418-5.620) and not receiving hypoglycemic therapy (OR = 1.697, 95% CI = 1.013-2.843) during follow-up increased the risk of stroke recurrence. We developed a prediction model using baseline pulse rate, hypoglycemic therapy, and physical activity, which produced an area under ROC curve (AUC) of 0.689.

Conclusion: Physical activity and hypoglycemic therapy play a protective role for IS patients with comorbid diabetes. In addition to targeted therapeutics, the improvement of daily-life habit contributes to slowing the progress of the IS.

Keywords: diabetes mellitus; ischemic stroke; nested case-control study; recurrence; risk factors.