title: Long-term risk of stroke in type 2 diabetes patients with diabetic ketoacidosis: A population-based, propensity score-matched, longitudinal follow-up study.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  T2D patients with previous DKA have a higher risk of stroke, especially ischaemic strokes.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi-Mei Medical Center, Chia-Li Branch, Tainan, Taiwan.
authors.forename: Y-L
authors.initials: YL
authors.lastname: Chen
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: S-F
authors.initials: SF
authors.lastname: Weng
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: C-Y
authors.initials: CY
authors.lastname: Yang
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan. Electronic address: cmmctkj@gmail.com.
authors.forename: K-J
authors.initials: KJ
authors.lastname: Tien
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology; D016883:Diabetic Ketoacidosis / Q000150:complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology
keywords: Diabetic ketoacidosis; Stroke; Type 2 diabetes