Poor outlook after stroke for type 1 diabetes patients
medwireNews: Nearly three-quarters of patients with type 1 diabetes have cardiovascular events and more than half die in the years following a stroke, a study shows.
The research by Per-Henrik Groop (Helsinki University Hospital, Finland) and colleagues was based on 144 patients with type 1 diabetes who had a stroke while participating in the Finnish Diabetic Nephropathy study (n=4083). During poststroke follow-up lasting an average of 3.4 years, 72% had a cardiovascular event, with 32% of these having a recurrent stroke, and 53% of all patients died, with nearly half of these having had a cardiovascular event prior to death.
The team found that patients’ chronic kidney disease (CKD) stage was a strong predictor for having cardiovascular events, with the highest risk increase being 6.71-fold for patients with stage 5 CKD (estimated glomerular filtration rate <15 mL/min per 1.73 m2 or dialysis) relative to those at stage 1 (normal kidney function).
However, Groop and team stress that there was a significantly increased risk even among patients with stage 2 CKD (60–89 mL/min per 1.73 m2), who had a 2.48-fold risk relative to those with normal kidney function.
“Prevention of stroke, and especially of diabetes-related kidney disease, is therefore of great importance to improve the prognosis of patients with type 1 diabetes,” write Groop et al in Diabetes Care.
Hemorrhagic stroke, as opposed to ischemic stroke, was also a strong predictor of recurrent events, but its main effects were during the first year after onset, when patients were extremely likely to die. After the first year, the mortality rate was similar for the two stroke subtypes.
The overall 5-year mortality rate was 42% and the patients were in their early 50s, on average, at the time of their stroke, whereas most strokes occur at around the ages of 60 to 80 years in type 2 diabetes patients and age 65 to 85 years in people without diabetes, say the researchers.
“Compared with the general population, not only is the mortality rate higher in patients with type 1 diabetes, but death also occurs much earlier, giving these young patients a far worse prognosis after a stroke than for subjects free of diabetes,” they say.
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