Association Between Diabetes and Stroke Subtype on Survival and Functional Outcome 3 Months After Stroke

Abstract

Background and Purpose— Although diabetes is a strong risk factor for stroke, it is still unclear whether stroke subtype, severity, and prognosis are different in diabetic and nondiabetic patients. We sought to evaluate stroke features, prognosis, and functional outcome in patients with diabetes compared with patients without diabetes. Methods— In a European Union Concerted Action involving 7 countries and 4537 patients hospitalized for a first-in-a-lifetime stroke, defined according to the Oxfordshire Community Stroke Project criteria, we collected data on demographics, risk factors, clinical presentation, and outcome. We used logistic regression to examine the relationship between diabetes and outcome at 3 months (disability, handicap, and death), controlling for risk factors, clinical presentation, and demographics. Results— Overall, diabetes was present in 937 patients (21%). Diabetic patients, compared with those without diabetes, were more likely to have limb weakness ( P <0.02), dysarthria ( P <0.001), ischemic stroke ( P <0.001), and lacunar cerebral infarction ( P =0.03). At 3 months, the case fatality rates were not higher in the diabetic groups ( P =0.33). Handicap (Rankin Scale) and disability (Barthel Index) were significantly higher in diabetic patients ( P =0.005 and P =0.016, respectively). Conclusions— Stroke in diabetic patients has a specific clinical pattern and a poor prognosis in terms of motor function, which emphasizes the need for early diagnosis and treatment of every case of diabetes.