title: Diabetes is an Independent Risk Factor for Stroke Recurrence in Stroke Patients: A Meta-analysis.
abstract: BACKGROUND
  This study aimed to assess the association between diabetes and risk of stroke recurrence (especially ischemic stroke recurrence) and to evaluate whether diabetes was an independent predictor for stroke recurrence in stroke patients with diabetes.
  
  
  METHODS
  The relevant studies were identified through searching databases of PubMed, EMBASE, and Cochrane library. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled to evaluate the association between diabetes and risk of stroke recurrence. Funnel plot and Egger's regression tests were used to assess publication bias. All statistical analyses were conducted in Stata 12.0.
  
  
  RESULTS
  Eighteen studies containing totally 43,899 participants were included in the meta-analysis. The results showed that stroke recurrence risk of all stroke patients with diabetes was significantly higher than those without diabetes (HR, 1.45; 95% CI, 1.32-1.59), similar results were achieved in ischemic stroke patients (HR, 1.44; 95% CI, 1.28-1.61), and there were no regional differences (Europe: HR, 1.28; 95% CI, 1.13-1.44; USA: HR, 1.89; 95% CI, 1.53-2.33; Asia: HR, 1.57, 95% CI, 1.28-1.92, respectively) and age differences (mean age <70 years: HR, 1.58; 95% CI, 1.34-1.86; mean age ≥70 years: HR, 1.27; 95% CI, 1.11-1.45, respectively). The heterogeneity of all included studies was not statistically significant, and no publication bias was observed.
  
  
  CONCLUSIONS
  This meta-analysis shows that diabetes is an independent risk factor for stroke recurrence in stroke patients.
authors.affiliation: General Practice Department, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Shou
authors.affiliation: Physical Examination Department, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhou
authors.affiliation: General Practice Department, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: shanzhuzhugh@163.com.
authors.forename: Shanzhu
authors.initials: S
authors.lastname: Zhu
authors.affiliation: General Practice Department, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Xiangjie
authors.initials: X
authors.lastname: Zhang
mesh_terms: D002545:Brain Ischemia / Q000150:complications / Q000209:etiology*; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000503:physiopathology*; D006801:Humans; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*
keywords: Diabetes; a meta-analysis; ischemic stroke recurrence; stroke recurrence