Stroke in patients with diabetes. The Copenhagen Stroke Study

Area of Science:

• Neurology
• Endocrinology
• Public Health

Background:

• Diabetes mellitus is a significant risk factor for cerebrovascular events.
• The specific differences in stroke presentation, severity, and outcomes between diabetic and non-diabetic patients remain incompletely understood.

Purpose of the Study:

• To investigate the differences in stroke characteristics, severity, prognosis, and the impact of admission glucose levels between patients with and without diabetes.
• To clarify the relationship between diabetes and acute stroke outcomes.

Main Methods:

• A community-based study involving 1135 acute stroke patients, with 20% diagnosed with diabetes.
• Weekly assessments of neurological deficits (Scandinavian Stroke Scale) and functional disabilities (Barthel Index) until rehabilitation completion.
• Computed tomographic (CT) scans were performed in 83% of patients to evaluate stroke characteristics.

Main Results:

• Diabetic stroke patients were younger and had higher rates of hypertension but less frequent intracerebral hemorrhages compared to non-diabetic patients.
• While initial stroke severity and lesion characteristics were similar, mortality was higher in diabetic patients (24% vs. 17%), with diabetes independently increasing death risk.
• Admission glucose levels independently predicted mortality in non-diabetic patients but not in those with diabetes; however, diabetic patients exhibited slower recovery.

Conclusions:

• Diabetes mellitus significantly influences multiple facets of stroke, affecting patient demographics, stroke subtype, recovery trajectory, and overall mortality.
• Elevated admission glucose levels are an independent predictor of mortality in non-diabetic stroke patients, a relationship not observed in diabetic individuals.
• Future clinical trials should explore the potential benefits of managing high admission glucose levels in non-diabetic stroke patients.