Research Article
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Evaluation of Demographic, Clinical, and Radiological Characteristics of Patients with Diabetes in Ischemic Stroke Patients

Year 2023, Volume: 49 Issue: 3, 375 - 379, 31.12.2023

Ayşen Akkurt Kocaeli Yasemin Dinç

https://doi.org/10.32708/uutfd.1384286

Abstract

Ischemic stroke is a common cause of disability and mortality worldwide, and its incidence is increasing in developing countries. Type 2 diabetes is a well-established risk factor for acute ischemic stroke. Diabetes is predicted to be associated with mortality and poor clinical outcomes after ischemic stroke. Diabetes and ischemic stroke are public health problems. This study aims to determine the demographic, clinical, and radiological characteristics of acute ischemic stroke patients with diabetes in our society and to determine the factors affecting ischemic stroke recurrence in patients with diabetes. This study evaluated 862 patients diagnosed with ischemic stroke in Bursa Uludağ University Faculty of Medicine Neurology between 2019 and 2021. Demographic, clinical, and radiological characteristics of the patients were recorded. Factors affecting ischemic stroke recurrence in diabetic and non-diabetic patients were questioned. In this study, risk factors such as coronary artery disease (p<0.01) and hypertension (p<0.01) were observed more frequently in acute ischemic stroke patients with diabetes, and ischemic stroke patients with diabetes had ischemic stroke recurrence (p=0.003) more often than those without diabetes. Variables associated with ischemic stroke recurrence in ischemic stroke patients with diabetes are; symptomatic atherosclerotic stenosis in the internal carotid artery (p=0.002), anterior circulation stroke (p<0.01), ischemic stroke due to extensive vessel atherosclerosis (p=0.029), and poor clinical outcome (p=0.016). The effect of glycemic control on prognosis and ischemic stroke recurrence in patients with diabetes could not be determined. We recommend that multicenter prospective studies be conducted to determine the relationship between glycemic control and stroke recurrence in diabetic patients.

Keywords

Type 2 diabetes ischemic stroke glycemic control Hba1C atherosclerotic vascular disease

References

  • 1.Katan M, Luft A. Global Burden of Stroke. Semin Neurol.2018; 38(2): 208-211.
  • 2.Mortality GBD, Causes of Death C. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: A systematic analysis for the global burden of disease study 2015. Lancet. 2016; 388: 1459- 1544.
  • 3.Hebert PR, Gaziano JM, Chan KS, Hennekens CH. Cholesterol-lowering with statin drugs, risk of stroke, and total mortality: an overview of randomized trials. JAMA.1997; 278: 313–321.
  • 4.Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as anindependent risk factor for stroke: the Framingham Study.Stroke.1991; 22:983–988.
  • 5.Prospective Studies Collaboration. Cholesterol, diastolic blood pressure and stroke: 13,000 strokes in 450,000 people in 45prospective cohorts. Lancet.1995; 346:1647–1653.
  • 6.Öcal E, Önsüz M. Diyabet Hastalığının Ekonomik Yükü. ESTÜDAM Halk Sağlığı Dergisi,2018; 3(1), 24-41.
  • 7.Charnogursky G. Neurological Complications of diabetes. Curr Neurol Neurosci Rep 2014; 14: 457.
  • 8.Shaw JE, Sicree RA, Zimmet PZ. Global estimates of theprevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010; 87(1): 4-14.
  • 9.Merel JA, Biessels GJ. Diabetes, hyperglycaemia, andacute ischaemic stroke, Lancet Neurol 2012; 11: 261-271.
  • 10.Ünal, E., Akan, O., & Üçler, S. (2015). Diyabet ve nörolojikhastalıklar. Okmeydanı Tıp Dergisi, 31(1), 45-51.
  • 11.American Diabetes Association. 2. Classification and Diagnosis of Diabetes [published correction appears in Diabetes Care. 2016; 39; 1653. Diabetes Care 2016; 39 Suppl 1: 13-22.
  • 12.Adams HP Jr, Bendixen BH, Kappelle JL, et al. Classification ofsubtype of acute ischemic stroke: definitions for use inamulticenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:3541
  • 13.Kumral E, Topcuoglu MA, Onal MZ. Anterior circulation syndromes. Handb Clin Neurol 2009;93:485-536.
  • 14.Easton DJ, Fauci AS, Isselbacher KJ. Cerebrovascular disease.In: Anonymous Harrison’s Principle of Internal Medicine. Fauci AS, Longo D, Kasper DL, Wilson JD, Martin JB, eds. New York: McGraw Hill, 1998:2325-2348.
  • 15.Weisscher N, Vermeulen M, Roos YB, de Haan RJ. Whatshould be defined as good outcome in stroke trials; a modified Rankin score of 0-1 or 0-2? J Neurol. 2008; 255(6):867-874
  • 16.Katakami N. Mechanism of Development of Atherosclerosisand Cardiovascular Disease in Diabetes Mellitus. J AtherosclerThromb. 2018 Jan 1;25(1):27-39.
  • 17.Armstrong EJ, Rutledge JC, Rogers JH. Coronary artery revascularization in patients with diabetes mellitus.Circulation. 2013; 128:1675–1685.
  • 18.Meschia JF, Bushnell C, Boden-Albala B et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; Council onHypertension. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45:3754–3832.
  • 19.La Sala L, Prattichizzo F, Ceriello A. The link between diabetesand atherosclerosis. Eur J Prev Cardiol. 2019; 26(2_suppl): 15-24.
  • 20.Zhao X, Li R, Hippe DS, Hatsukami TS, Yuan C; CARE-II Investigators. Chinese Atherosclerosis Risk Evaluation (CARE II)study: a novel cross-sectional, multicentre study of the prevalence of high-risk atherosclerotic carotid plaque in Chinese patients with ischaemic cerebrovascular events-design and rationale. Stroke Vasc Neurol. 2017; 2(1):15-20.
  • 21.King P, Peacock I, Donnelly R. The UK prospective diabetes study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol. 1999; 48(5):643-648.
  • 22.Diabetes Control and Complications Trial (DCCT): results of feasibility study. The DCCT Research Group. Diabetes Care. 1987; 10(1): 1-19.
  • 23.Idris I, Thomson GA, Sharma JC. Diabetes mellitus andstroke. Int J Clin Pract 2006;60(1):48-56
  • 24.Merel JA, Biessels GJ. Diabetes, hyperglycaemia, and acute ischaemic stroke, Lancet Neurol 2012;11:261- 271
  • 25.Rohit R. Das, MD, Seshadri S. Diabetes and Stroke.DM Current Cardiovascular Risk Reports 2009; 3: 35-41.
  • 26.Li YY, Zhang S, Wang H, Zhang SX, Xu T, Chen SW et al.Identification of Crucial Genes and Pathways Associated with Atherosclerotic Plaque in Diabetic Patients. Pharmgenomics Pers Med. 2021; 14: 211-220.

İskemik İnmeli ve Diyabeti Olan Hastaların Demografik, Klinik ve Radyolojik Özelliklerinin Değerlendirilmesi

Year 2023, Volume: 49 Issue: 3, 375 - 379, 31.12.2023

Ayşen Akkurt Kocaeli Yasemin Dinç

https://doi.org/10.32708/uutfd.1384286

Abstract

İskemik inme, dünya çapında sakatlık ve mortalitenin yaygın nedenlerinden biridir ve gelişmekte olan ülkelerde görülme sıklığı artmaktadır. Tip 2 diyabet, akut iskemik inme için iyi tanımlanmış bir risk faktörüdür. Diyabetin iskemik inme sonrası mortalite ve kötü klinik sonuçla ilişkili olduğu tahmin edilmektedir. Diyabet ve iskemik inme halk sağlığı sorunlarıdır. Bu çalışmanın amacı toplumumuzdaki diyabetli akut iskemik inme hastalarının demografik klinik ve radyolojik özelliklerini belirlemek ve diyabetli hastalarda iskemik inme rekürrensini etkileyen faktörleri belirlemektir. Bu çalışmada 2019-2021yılları arasında Bursa Uludağ Üniversitesi Tıp Fakültesi Nöroloji bölümünde iskemik inme tanısı alan 862 hasta değerlendirildi. Hastaların demografik, klinik ve radyolojik özellikleri kaydedildi. Diyabetik olan ve olmayan hastaların iskemik inme rekürrensine etki eden faktörler sorgulandı. Bu çalışmada diyabetli akut iskemik inme hastalarında koroner arter hastalığı (p<0.01), hipertansiyon (p<0.01) gibi risk faktörlerinin daha sık görüldüğü, diyabeti olan iskemik inme hastalarda diyabeti olmayanlara göre daha sık iskemik inme rekürrensi (p=0.003) görüldüğü belirlendi. Diyabetli iskemik inme hastalarında iskemik inme rekürrensi olan ve olmayan hastalar kıyaslandığında, iskemik inme rekürrensi ile internal karotid arterde semptomatik aterosklerotik stenoz (p=0.002), anterior sirkülasyon inmesi (p<0.01), büyük damar aterosklerozuna bağlı iskemik inme (p=0.029) ve kötü klinik sonlanım (p=0.016) arasında anlamlı istatistiksel ilişki saptandı. Diyabetli hastalarda glisemik kontrolün prognoza ve iskemik inme rekürrensine etkisi belirlenmedi. Diyabetik hastalarda glisemik kontrolün inme rekürrensi ile ilişkisini belirlemek için çok merkezli prospektif çalışmaların yapılmasını öneriyoruz.

Keywords

Tip 2 diyabet iskemik inme glisemik kontrol Hba1C aterosklerotik damar hastalığı

References

  • 1.Katan M, Luft A. Global Burden of Stroke. Semin Neurol.2018; 38(2): 208-211.
  • 2.Mortality GBD, Causes of Death C. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: A systematic analysis for the global burden of disease study 2015. Lancet. 2016; 388: 1459- 1544.
  • 3.Hebert PR, Gaziano JM, Chan KS, Hennekens CH. Cholesterol-lowering with statin drugs, risk of stroke, and total mortality: an overview of randomized trials. JAMA.1997; 278: 313–321.
  • 4.Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as anindependent risk factor for stroke: the Framingham Study.Stroke.1991; 22:983–988.
  • 5.Prospective Studies Collaboration. Cholesterol, diastolic blood pressure and stroke: 13,000 strokes in 450,000 people in 45prospective cohorts. Lancet.1995; 346:1647–1653.
  • 6.Öcal E, Önsüz M. Diyabet Hastalığının Ekonomik Yükü. ESTÜDAM Halk Sağlığı Dergisi,2018; 3(1), 24-41.
  • 7.Charnogursky G. Neurological Complications of diabetes. Curr Neurol Neurosci Rep 2014; 14: 457.
  • 8.Shaw JE, Sicree RA, Zimmet PZ. Global estimates of theprevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010; 87(1): 4-14.
  • 9.Merel JA, Biessels GJ. Diabetes, hyperglycaemia, andacute ischaemic stroke, Lancet Neurol 2012; 11: 261-271.
  • 10.Ünal, E., Akan, O., & Üçler, S. (2015). Diyabet ve nörolojikhastalıklar. Okmeydanı Tıp Dergisi, 31(1), 45-51.
  • 11.American Diabetes Association. 2. Classification and Diagnosis of Diabetes [published correction appears in Diabetes Care. 2016; 39; 1653. Diabetes Care 2016; 39 Suppl 1: 13-22.
  • 12.Adams HP Jr, Bendixen BH, Kappelle JL, et al. Classification ofsubtype of acute ischemic stroke: definitions for use inamulticenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:3541
  • 13.Kumral E, Topcuoglu MA, Onal MZ. Anterior circulation syndromes. Handb Clin Neurol 2009;93:485-536.
  • 14.Easton DJ, Fauci AS, Isselbacher KJ. Cerebrovascular disease.In: Anonymous Harrison’s Principle of Internal Medicine. Fauci AS, Longo D, Kasper DL, Wilson JD, Martin JB, eds. New York: McGraw Hill, 1998:2325-2348.
  • 15.Weisscher N, Vermeulen M, Roos YB, de Haan RJ. Whatshould be defined as good outcome in stroke trials; a modified Rankin score of 0-1 or 0-2? J Neurol. 2008; 255(6):867-874
  • 16.Katakami N. Mechanism of Development of Atherosclerosisand Cardiovascular Disease in Diabetes Mellitus. J AtherosclerThromb. 2018 Jan 1;25(1):27-39.
  • 17.Armstrong EJ, Rutledge JC, Rogers JH. Coronary artery revascularization in patients with diabetes mellitus.Circulation. 2013; 128:1675–1685.
  • 18.Meschia JF, Bushnell C, Boden-Albala B et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; Council onHypertension. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45:3754–3832.
  • 19.La Sala L, Prattichizzo F, Ceriello A. The link between diabetesand atherosclerosis. Eur J Prev Cardiol. 2019; 26(2_suppl): 15-24.
  • 20.Zhao X, Li R, Hippe DS, Hatsukami TS, Yuan C; CARE-II Investigators. Chinese Atherosclerosis Risk Evaluation (CARE II)study: a novel cross-sectional, multicentre study of the prevalence of high-risk atherosclerotic carotid plaque in Chinese patients with ischaemic cerebrovascular events-design and rationale. Stroke Vasc Neurol. 2017; 2(1):15-20.
  • 21.King P, Peacock I, Donnelly R. The UK prospective diabetes study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol. 1999; 48(5):643-648.
  • 22.Diabetes Control and Complications Trial (DCCT): results of feasibility study. The DCCT Research Group. Diabetes Care. 1987; 10(1): 1-19.
  • 23.Idris I, Thomson GA, Sharma JC. Diabetes mellitus andstroke. Int J Clin Pract 2006;60(1):48-56
  • 24.Merel JA, Biessels GJ. Diabetes, hyperglycaemia, and acute ischaemic stroke, Lancet Neurol 2012;11:261- 271
  • 25.Rohit R. Das, MD, Seshadri S. Diabetes and Stroke.DM Current Cardiovascular Risk Reports 2009; 3: 35-41.
  • 26.Li YY, Zhang S, Wang H, Zhang SX, Xu T, Chen SW et al.Identification of Crucial Genes and Pathways Associated with Atherosclerotic Plaque in Diabetic Patients. Pharmgenomics Pers Med. 2021; 14: 211-220.
There are 26 citations in total.

Details

Primary Language Turkish
Subjects Endocrinology
Journal Section Research Article
Authors

Ayşen Akkurt Kocaeli 0000-0001-7604-0605

Yasemin Dinç 0000-0003-0342-5939

Publication Date December 31, 2023
Submission Date November 1, 2023
Acceptance Date December 1, 2023
Published in Issue Year 2023 Volume: 49 Issue: 3

Cite

APA Akkurt Kocaeli, A., & Dinç, Y. (2023). İskemik İnmeli ve Diyabeti Olan Hastaların Demografik, Klinik ve Radyolojik Özelliklerinin Değerlendirilmesi. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 49(3), 375-379. https://doi.org/10.32708/uutfd.1384286
AMA Akkurt Kocaeli A, Dinç Y. İskemik İnmeli ve Diyabeti Olan Hastaların Demografik, Klinik ve Radyolojik Özelliklerinin Değerlendirilmesi. Uludağ Tıp Derg. December 2023;49(3):375-379. doi:10.32708/uutfd.1384286
Chicago Akkurt Kocaeli, Ayşen, and Yasemin Dinç. “İskemik İnmeli Ve Diyabeti Olan Hastaların Demografik, Klinik Ve Radyolojik Özelliklerinin Değerlendirilmesi”. Uludağ Üniversitesi Tıp Fakültesi Dergisi 49, no. 3 (December 2023): 375-79. https://doi.org/10.32708/uutfd.1384286.
EndNote Akkurt Kocaeli A, Dinç Y (December 1, 2023) İskemik İnmeli ve Diyabeti Olan Hastaların Demografik, Klinik ve Radyolojik Özelliklerinin Değerlendirilmesi. Uludağ Üniversitesi Tıp Fakültesi Dergisi 49 3 375–379.
IEEE A. Akkurt Kocaeli and Y. Dinç, “İskemik İnmeli ve Diyabeti Olan Hastaların Demografik, Klinik ve Radyolojik Özelliklerinin Değerlendirilmesi”, Uludağ Tıp Derg, vol. 49, no. 3, pp. 375–379, 2023, doi: 10.32708/uutfd.1384286.
ISNAD Akkurt Kocaeli, Ayşen - Dinç, Yasemin. “İskemik İnmeli Ve Diyabeti Olan Hastaların Demografik, Klinik Ve Radyolojik Özelliklerinin Değerlendirilmesi”. Uludağ Üniversitesi Tıp Fakültesi Dergisi 49/3 (December 2023), 375-379. https://doi.org/10.32708/uutfd.1384286.
JAMA Akkurt Kocaeli A, Dinç Y. İskemik İnmeli ve Diyabeti Olan Hastaların Demografik, Klinik ve Radyolojik Özelliklerinin Değerlendirilmesi. Uludağ Tıp Derg. 2023;49:375–379.
MLA Akkurt Kocaeli, Ayşen and Yasemin Dinç. “İskemik İnmeli Ve Diyabeti Olan Hastaların Demografik, Klinik Ve Radyolojik Özelliklerinin Değerlendirilmesi”. Uludağ Üniversitesi Tıp Fakültesi Dergisi, vol. 49, no. 3, 2023, pp. 375-9, doi:10.32708/uutfd.1384286.
Vancouver Akkurt Kocaeli A, Dinç Y. İskemik İnmeli ve Diyabeti Olan Hastaların Demografik, Klinik ve Radyolojik Özelliklerinin Değerlendirilmesi. Uludağ Tıp Derg. 2023;49(3):375-9.
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