Oral Presentation Asia Pacific Stroke Conference 2024

Twenty-Year Trend in prevalence and outcome of diabetes in acute ischemic stroke：Japan Stroke Data Bank (107156)

Kaori Miwa 1 , Sohei Yoshimura 1 , Shinichi Wada 2 , Shuhei Egashira 1 , Tomohide Yoshie 1 , Junji Miyazaki 2 , Yoshiki Yagita 3 , Kenji Kamiyama 4 , Yukako Yazawa 5 , Yoshihiro Miyamoto 2 , Shotai Kobayashi 6 , Kazuo Minematsu 7 , Kazunori Toyoda 1 , Masatoshi Koga 1
  1. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
  2. Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
  3. Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan
  4. Nakamura Memorial Hospital, Sapporo , Hokkaido, Japan
  5. Department of Stroke Neurology, Kohnan Hospital, Sendai, Miyagi, Japan
  6. Shimane University School of Medicine, Izumo, Shimane, Japan
  7. ISEIKAI International General Hospital, Osaka, Japan

Backgrounds/Aims

It is uncertain how the burden of diabetes on stroke prognosis changed over 2 decades.

 

Methods

The subjects included patients with acute ischemic stroke (AIS) enrolled in a nationwide, hospital-based, multicenter prospective study between January 2001 and December 2020. The outcome measure included the prevalence of diabetes and unfavorable outcome defined as modified Rankin Scale score of 3–6 at discharge. Mixed-effect logistic regression models were used to evaluate trends of each outcome, after adjustment for covariates. Jointpoint regression models were used to compute average annualized percent change of each outcome by age group (18-40, 40-50, 50-60, 60-70, 70-80, ≥90 years).

 

Results

Among 154,182 patients hospitalized, 42,538 patients (27.6%) had diabetes. The prevalence of diabetes decreased throughout the 20-year period (adjusted-OR, 0.968 [95% CI, 0.956-0.981] per 5yr). The prevalence of diabetes was decreased annually for 50-70 years, but increased for 70-90 and ≥90 years, respectively. Overall, the proportion of unfavorable outcome were similar between those with or without diabetes. However, the unfavorable outcome decreased over time in patients without diabetes (adOR, 0.948 [0.931-0.965], ptrend =<0.001), but this was not observed in those with diabetes (adOR, 0.976 [0.945-1.007], ptrend =0.131). Rates of unfavorable outcome decreased annually in patients without diabetes aged 50-90 years, but only in those with diabetes aged 70-80 years.

 

Conclusion

Over 2 decades, the prevalence of diabetes increased in AIS patients aged 70 years or older. The lack of secular improvement in stroke prognosis was observed in patients with diabetes, suggesting an unmet need in this population.