The Natural History of Stroke in Diabetic Patients

Abstract

A 5 yr follow-up of 53 diabetic patients admitted for their 1st stroke in 1972-73 was performed. They were compared with 2 groups of 53 non-diabetic patients each with cerebrovascular disease (CVD), 1 randomly selected and 1 matched with the diabetics for age, sex and diagnosis of CVD at discharge. All patients could be traced at follow-up. The mean age at the time of 1st stroke was 66.5 yr in male and 73.2 yr in female diabetics. Manifest diabetes was diagnosed in 19% during hospitalization for stroke; of the remainder, 74% had had diabetes since less than 10 yr. In 85% of the diabetics there were no signs of severe angiopathy affecting eyes, kidneys or lower extremities. The majority of diabetic as well as non-diabetic CVD patients had a history of hypertension and/or heart disease. Few were overweight. Case fatality rate was significantly higher in diabetics than in non-diabetics throughout the follow-up (P < 0.01 for diabetics vs. matched non-diabetics, P < 0.001 for diabetics vs. randomly selected non-diabetics). The presence of heart disorder predicted mortality in the diabetic subjects. Hypertension diagnosed before stroke involved a more favorable long-term prognosis in all 3 groups (P < 0.05). The major causes of death in diabetic CVD patients were cardiac disorders (50%) and stroke (47%). Previous investigations have identified diabetes as a risk factor for stroke. This study shows that diabetes also adversely affects the short-term as well as the long-term outcome in stroke.