Diabetes and long-term outcomes of ischaemic stroke: findings from Get With The Guidelines-Stroke
Open accessAbstract
Aims: There is a paucity of data on the influence of diabetes on long-term outcomes after ischaemic stroke (IS). We assessed whether outcomes after IS differ between patients with and without diabetes. Methods and results: Patients aged ≥65 years (n = 409 060) in Get With The Guidelines-Stroke (nationwide registry of stroke patients from 1690 sites in the USA) were followed for 3 years post-discharge. The outcomes of interest were mortality, cardiovascular and non-cardiovascular hospitalizations, heart failure (HF), and recurrence of IS/transient ischaemic attack (TIA). Patients with diabetes (29.6%) were younger and had more comorbidities. At 3 years post-discharge after IS, diabetes was associated with higher risks of adverse outcomes: all-cause mortality [cumulative incidence 46.0% vs. 44.2%, absolute difference (AD) 1.8%; adjusted hazard ratio (aHR) 1.24, 95% confidence interval 1.23-1.25], all-cause readmission (71.3% vs. 63.7%, AD 7.6%; aHR 1.22, 1.21-1.23), composite of mortality and all-cause readmission (84.1% vs. 79.3%, AD 4.8%; aHR 1.21, 1.20-1.22), composite of mortality and cardiovascular readmission (69.5% vs. 64.3%, AD 5.2%; aHR 1.19, 1.18-1.20), IS/TIA readmission (15.9% vs. 13.3%, AD 2.6%; aHR 1.18, 1.16-1.20), HF readmission (10.3% vs. 6.4%, AD 3.9%; aHR 1.60, 1.56-1.64), non-cardiovascular readmission (58.3% vs. 50.3%, AD 8.0%; aHR 1.28, 1.26-1.29), and non-IS/TIA readmission (67.6% vs. 59.7%, AD 7.9%; aHR 1.23, 1.22-1.25). Accounting for the initial severity of stroke using the National Institute of Health Stroke Scale as well as using propensity score matching method as a sensitivity analysis, did not modify the results. Conclusion: Among older IS patients diabetes was associated with increased risks of death, cardiovascular and non-cardiovascular hospitalizations, HF, and IS/TIA recurrence.
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People with diabetes have a poorer prognosis after stroke than people without diabetes.
“People living with diabetes are at higher risk for stroke and have a poorer prognosis following a stroke event than those without diabetes.”
From Benefits of GLP-1 (Glucagon-Like Peptide 1) Receptor Agonists for Stroke Reduction in Type 2 Diabetes: A Call to Action for Neurologists (2022) · cites this paper as [5]
Long-term, people with both diabetes and stroke remain at higher risk for recurrent TIA/stroke, heart failure, and death.
“Long-term, people with both diabetes and stroke continue to be at higher risk for adverse events, including recurrent transient ischemic attack (TIA)/stroke, heart failure, and death.5”
From Benefits of GLP-1 (Glucagon-Like Peptide 1) Receptor Agonists for Stroke Reduction in Type 2 Diabetes: A Call to Action for Neurologists (2022) · cites this paper as [5]
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- Authors
- Echouffo-Tcheugui, J. B., Xu, H., Matsouaka, R. A., Xian, Y., Schwamm, L. H., Smith, E. E., Bhatt, D. L., Hernandez, A. F., Heidenreich, P. A., & Fonarow, G. C.
- Affiliations
- Brigham and Women's Hospital (US)
- Duke University (US)
- Duke Medical Center (US)
- Harvard University (US)
- University of Calgary (CA)
- Stanford Medicine (US)
- University of California, Los Angeles (US)
- Corresponding author
- Fonarow, Gregg C
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-02-09
- Volume
- 39
- Issue
- 25
- Pages
- 2376-2386
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC6031049
- OpenAlex
- W2789744550
- Cited by
- 103
- References
- 56
- Citations by year
- 2026: 9 · 2025: 18 · 2024: 16 · 2023: 10 · 2022: 15 · 2021: 12 · 2020: 12 · 2019: 5 · 2018: 6
- FWCI
- 6.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Guidelines-Stroke
- American Heart Association
- American Stroke Association
- Janssen Pharmaceutical Companies of Johnson & Johnson
- Boeringher-Ingelheim
- Merck
- Bristol-Myers Squib/Sanofi Pharmaceutical Partnership
- AHA Pharmaceutical Roundtable
- Young Investigator Database Research
- National Heart, Lung, and Blood Institute (T32 HL125232)
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Neurological and metabolic disorders
- Keywords
- diabetes mellitus, ischemic stroke, long-term outcomes, all-cause mortality, hospital readmission, heart failure, stroke recurrence, transient ischemic attack, cardiovascular hospitalization, older adults, Get With The Guidelines-Stroke registry, post-discharge follow-up, comorbidities, stroke risk stratification, secondary stroke prevention
- MeSH terms
- Aged, Aged, 80 and over, Brain Ischemia, Female, Follow-Up Studies, Humans, Male, Registries, Time Factors, United States, Stroke, Diabetes Complications
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