Management of Diabetes in Stroke

Introduction

Diabetes mellitus is a global health problem. About 350 million people worldwide are affected and this number is expected to increase by a staggering 50% in the next decade because of increases in the prevalence of obesity and inactivity . Type 1 diabetes mellitus, which accounts for about 10% of all cases, is an autoimmune disease where there is immune destruction of the insulin-producing pancreatic β-cells . Type 2 diabetes mellitus, representing 90% of people with diabetes, is caused by progressive pancreatic β-cell failure in the context of increased insulin resistance .

Diabetes as a Risk Factor for Stroke

Diabetes is a well-recognized risk factor for stroke and there may be a sexual dimorphism in the stroke risk imposed by diabetes. A recent systematic review and meta-analysis of 64 cohorts, including 775,385 individuals and 12,539 strokes, is instructive in this regard . The duration of follow-up was between 5 and 32 years and included data on both fatal and nonfatal strokes. Compared with individuals without diabetes, those with diabetes, not surprisingly, had higher systolic blood pressure, total cholesterol levels, body mass index, and waist circumference and lower high-density lipoprotein cholesterol fraction. The overall pooled relative risk (RR) for fatal and nonfatal strokes associated with diabetes was 2.28 [95% confidence interval (CI), 1.93–2.69] in women and 1.83 (1.60–2.08) in men. Adjustment for other cardiovascular risk factors had little effect on the RR for stroke, which remained higher in diabetic people but higher in diabetic women than in diabetic men. The RR for fatal stroke was 2.29 (1.73–3.04) in women and 1.74 (1.45–2.08) in men. Sensitivity analyses showed that the increased stroke risk did not vary by region, age, duration of follow-up study, smoking status, year of study baseline, stroke subtype, method of diabetes ascertainment, or data source. Possible reasons for the gender differences are beyond the scope of this chapter and discussed in reference . The point is that diabetes imposes a large excess risk for stroke.

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