Diabetic and non-diabetic subjects with ischemic stroke: differences, subtype distribution and outcome.
OBJECTIVE
Diabetes mellitus increases the risk of stroke, and pathophysiological changes of diabetic cerebral vessels may differ in comparison with non-diabetic ones; nonetheless, the clinical and prognostic profile of stroke in diabetic patients is not yet fully understood. On this basis, the aim of our study was to evaluate cerebrovascular risk factor prevalence in diabetic stroke patients in comparison with non-diabetics, to analyze whether diabetics have a different prevalence of stroke subtypes as classified by the TOAST classification, and determine whether diabetics and non-diabetics have a different prognosis.


RESULTS
We enrolled 102 diabetics and 204 non-diabetic subjects with acute ischemic stroke, matched by sex and age (+/-3 years). We used as outcome indicators the Scandinavian Stroke Scale (SSS) score at admission and the modified Rankin disability scale at discharge and at a 6-month follow-up. We classified ischemic stroke according to the TOAST classification. Diabetes was associated with lacunar ischemic stroke subtype, with a record of hypertension, and with a better SSS score at admission. The association of diabetes with lacunar stroke remained significant even after adjustment for hypertension or for large artery atherosclerotic and cardioembolic stroke subtypes.


CONCLUSIONS
Our study shows some significant differences in acute ischemic stroke among diabetics in comparison with non-diabetics (higher frequency of hypertension, higher prevalence of lacunar stroke subtype, lower neurological deficit at admission in diabetics).
Tuttolomondo
Antonino
A
Biomedical Department of Internal and Specialistic Medicine, University of Palermo, P.zza delle Cliniche n.2, 90127 Palermo, Italy.
Pinto
Antonio
A
Salemi
Giuseppe
G
Di Raimondo
Domenico
D
Di Sciacca
Riccardo
R
Fernandez
Paola
P
Ragonese
Paolo
P
Savettieri
Giovanni
G
Licata
Giuseppe
G
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications* / Q000453:epidemiology; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000145:classification / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D020127:Recovery of Function; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors