title: Type of preadmission antidiabetic treatment and outcome among patients with ischemic stroke: a nationwide follow-up study.
abstract: BACKGROUND
  We examined whether the preadmission use of sulfonylureas is associated with improved clinical outcome compared with other antidiabetic treatments after hospitalization with ischemic stroke.
  
  
  METHODS
  We conducted a nationwide population-based follow-up study among all Danish patients hospitalized with ischemic stroke between 2003 and 2006 and who were registered in the Danish National Indicator Project. We obtained data on diabetes and type of antidiabetic treatment, patient characteristics, in-hospital quality of care, and mortality and readmissions by linking medical databases. We computed mortality rates and rates of readmission recurrent ischemic stroke or myocardial infarction according to type of treatment and used the Cox proportional hazards regression analysis to compute hazard ratios (HRs).
  
  
  RESULTS
  We identified 4817 stroke patients with type 2 diabetes mellitus. We found lower 30-day mortality rates among users of metformin (adjusted HR 0.32; 95% confidence interval [CI] 0.15-0.68), insulin (adjusted HR 0.47; 95% CI 0.27-0.81), and patients without antidiabetic pharmacotherapy (adjusted HR 0.58; 95% CI 0.36-0.93) compared with users of sulfonylureas. Users of any combination had a nonstatistical significant lower 30-day mortality rate (adjusted HR 0.64; 95% CI 0.34-1.21). In contrast, we found no significant differences in 1-year mortality rate. Compared with users of sulfonylureas, users of all other types of treatment had increased risk of readmission; however, it did not reach statistical significance for all treatment groups.
  
  
  CONCLUSIONS
  Preadmission use of sulfonylureas appeared not to be associated with an overall improved clinical outcome among type 2 diabetic patients admitted with ischemic stroke.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. ht@dce.au.dk
authors.forename: Henriette Thisted
authors.initials: HT
authors.lastname: Horsdal
authors.forename: Frank
authors.initials: F
authors.lastname: Mehnert
authors.forename: Jørgen
authors.initials: J
authors.lastname: Rungby
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003718:Denmark / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006760:Hospitalization; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D010359:Patient Readmission; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013453:Sulfonylurea Compounds / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D008687:Metformin