Subtype and severity of stroke at presentation in subjects with and without type 2 diabetes Saifuddin M, Rahman MM, Sharifuzzaman M, Selim S, Kamrul-Hasan A B, Uddin MN, Akter F, Mahbub MI, Ahammed A, Ghosh DK - Bangladesh J Endocrinol Metab  
  • Users Online: 128
  • Print this page
  • Email this page

 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 1  |  Issue : 1  |  Page : 19-21

Subtype and severity of stroke at presentation in subjects with and without type 2 diabetes


1 Department of Endocrinology, Dhaka Medical College, Sylhet, Bangladesh
2 Medical Officer, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh
3 Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Bangladesh
4 Department of Endocrinology, Mymensingh Medical College, Bangladesh
5 Surgical Oncologist, BGB, Bangladesh
6 Department of Endocrinology, Chattogram Medical College, Bangladesh
7 Department of Endocrinology, Sheikh Hasina National Institute of Burn and Plastic Surgery, Bangladesh
8 Department of Endocrinology, NITOR, Bangladesh
9 Department of Endocrinology, Khulna Medical College, Bangladesh
Date of Submission28-Apr-2022
Date of Decision02-Jun-2022
Date of Acceptance04-Jun-2022
Date of Web Publication26-Aug-2022

Correspondence Address:
Dr. Mohammad Saifuddin
Dhaka Medical College, Dhaka
Bangladesh
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjem.bjem_3_22

Rights and Permissions
  Abstract 


Background: Although diabetes is a strong risk factor for stroke, it is still unclear whether stroke subtype and severity at presentation are different in patients with and without diabetes. Objective: The objective of the study was to identify the subtype and severity of stroke at presentation in diabetic versus nondiabetic subjects in our population. Methods: This cross-sectional comparative study was conducted in the Departments of Neurology and Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, from July 2011 to December 2011. Forty-seven stroke patients with diabetes and 47 nondiabetic patients with stroke were included in the study. Results: The mean age of the patients of the diabetic group was lower than the nondiabetic group (60.4 [standard deviation (SD) ± 10.5] vs. 65.4 [SD ± 10.3], P< 0.05), but there was no sex difference between the two groups. Hypertension and stroke severity was more in diabetics (Scandinavian Stroke Scale: 21.2 vs. 28.1, P< 0.001). Ischemic stroke was significantly more in the diabetic group than that of the nondiabetic group (83.0% vs. 59.6%, P< 0.01). Subtypes of hemorrhagic stroke and ischemic stroke were almost similar in both the diabetic and nondiabetic groups. Conclusion: Stroke in diabetic patients is different from stroke in nondiabetic patients in several aspects. The diabetic stroke patient is younger, ischemic stroke and stroke severity is more, but hemorrhagic stroke is less in diabetic individuals.

Keywords: Diabetes mellitus, patients, severity, stroke, subtype


How to cite this article:
Saifuddin M, Rahman MM, Sharifuzzaman M, Selim S, Kamrul-Hasan A B, Uddin MN, Akter F, Mahbub MI, Ahammed A, Ghosh DK. Subtype and severity of stroke at presentation in subjects with and without type 2 diabetes. Bangladesh J Endocrinol Metab 2022;1:19-21

How to cite this URL:
Saifuddin M, Rahman MM, Sharifuzzaman M, Selim S, Kamrul-Hasan A B, Uddin MN, Akter F, Mahbub MI, Ahammed A, Ghosh DK. Subtype and severity of stroke at presentation in subjects with and without type 2 diabetes. Bangladesh J Endocrinol Metab [serial online] 2022 [cited 2022 Sep 30];1:19-21. Available from: https://www.bjem.org/text.asp?2022/1/1/19/354774




  Introduction Top


Cerebrovascular insult or stroke is a crisis in cerebrovascular circulation and central nervous system function with focal neurologic dysfunction.[1] Stroke is the second leading cause of death worldwide, and the vast majority of these stroke-related deaths occur in low- and middle-income countries.[2],[3] Worldwide 5.5 million people died of stroke in 2002,[4] and roughly 20% of these deaths occurred in South Asia.[5] It is estimated that the number of deaths from stroke will increase to 6.3 million in 2015 and 7.8 million by 2030 with the bulk occurring in the poor countries of the world.[6]

Diabetes mellitus is a modifiable risk factor for ischemic stroke.[7] In people with Type 2 diabetes mellitus, there is a 2–5 fold increased risk for stroke compared with those without diabetes. Modifiable risk factors for stroke include hypertension, diabetes mellitus, dyslipidemia, cigarette smoking, cardiac disease, drug abuse, and heavy alcohol consumption.[8] Risk factors for stroke in diabetic patients include elevated blood pressure, smoking, age, male sex, atrial fibrillation, and hyperglycemia.[9] The significance of diabetes as a risk factor for hemorrhagic stroke differs in different studies. In the Honolulu Heart Program, diabetes was not associated with an increased risk of hemorrhagic stroke in Japanese-American men, whereas in the Framingham study, there was a 4.5-fold risk of hemorrhagic stroke in men with diabetes.[10],[11] In a population-based study from Finland, diabetes was a risk factor for cerebral infarction and unclassified stroke, whereas there was no association between diabetes and subarachnoid and intracerebral hemorrhage.[12]

As there is a paucity of local data in this topic, this study is therefore planned to identify the subtype and severity of stroke at presentation in diabetic versus nondiabetic subjects in our population.


  Methods Top


It was a hospital-based cross-sectional comparative study conducted at the Departments of Neurology and Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet. Ethical approval from the Ethical Approval Committee was obtained before the commencement of the study. Informed written consent was taken from participants after complete explanation of the procedure and purpose of the study. Consecutive admitted diagnosed stroke patients regardless of age and gender during the study period from July 2011 to December 2011 were included in this study. Forty-seven diabetic patients with stroke and 47 nondiabetic patients with stroke were included in the study. Diabetes was defined as per the definition of the American Diabetes Association guideline. Ischemic stroke and hemorrhagic stroke severity was determined using the Scandinavian Stroke Scale (SSS) with severe stroke defined as an SSS score ≤25. Patients with transient ischemic attack, history of previous stroke, head injury, patients on anticoagulants or steroids prior, and patients who refuse to participate were not included in the study. A predesigned questionnaire and data sheet were used to collect sociodemographic, clinical, and laboratory information. Collected data were sorted and screened for any discrepancy. The edited data were then entered into the template of SPSS® 16. Student's t-test and Chi-square test were applied. P< 0.05 was taken as statistically significant.


  Results Top


In this study, the age of the patients ranged from 30 to 83 years with a mean age of 60.4 (standard deviation [SD] ± 10.5) years in the diabetic group, whereas in the nondiabetic group, 40–90 years with a mean age of 65.4 (SD ± 10.3) years. There were 36 (76.6%) males and 11 (29.8%) females in the diabetic group whereas 33 (70.2%) males and 14 (29.8%) females in the nondiabetic group. Twenty-one (44.7%) patients of the diabetic group were smokers, and in the nondiabetic group, it was 25 (53.2%). The study revealed that 27 (57.4%) patients of diabetes were hypertensive and 17 (36.2%) patients of nondiabetes were hypertensive. Admission SSS score was significantly low in the diabetic group than that of the nondiabetic group (21.2 [SD ± 10.1] vs. 28.1 [SD ± 11.6], Z = 3.09, P < 0.001). The study also revealed that the frequency of severe stroke was significantly high in the diabetic group than that of the nondiabetic group (38 [80.9%] vs. 15 [31.9%], X2 = 22.88, P < 0.001). Ischemic stroke in the diabetic group (83.0%) was significantly more than that of the nondiabetic group (59.6%) (Chi-square value: 6.287, P = 0.012) [Table 1].
Table 1: Distribution of patients according to the type of stroke

Click here to view


In the diabetic group, subtypes of hemorrhagic stroke were lobar (2 [25.0%]), basal ganglion (3 [37.5%]), thalamus (1 [12.5%]), and brain stem (2 [25.0%]), whereas in the nondiabetic group, subtypes of hemorrhagic stroke were lobar (5 [26.3%]), basal ganglion (7 [36.6%]), thalamus (5 [26.3%]), and brain stem (2 [10.5%]) [Table 2]. In the diabetic group, subtypes of ischemic stroke were cortical infarcts (18 [46.2%]), subcortical infarcts (11 [28.2%]), brain stem (5 [12.8%]), cerebellum (3 [7.7%]), and unclassified (2 [5.1%]), whereas in the nondiabetic group, subtypes of ischemic stroke were cortical infarcts (15 [63.6%]), subcortical infarcts (8 [28.6%]), brain stem (2 [7.1%]), cerebellum (2 [7.1%]), and unclassified (1 [3.6%]).
Table 2: Distribution of patients according to the subtype of hemorrhagic stroke

Click here to view



  Discussion Top


The mean age of the patients of the diabetic group was significantly lower than the nondiabetic group. This result was supported by Jørgensen et al.,[12] but Zafar et al. found no age difference between diabetic and nondiabetic stroke patients.[8] In this study, 27 (57.4%) patients of the diabetic group were hypertensive and 17 (36.2%) patients of the nondiabetic group were hypertensive. The difference between the two groups was statistically significant (P < 0.05). This result was supported by Sarkar et al. that diabetic patients who is admitted for stroke are significantly more hypertensive (70.9%) than that of nondiabetic patients (47.6%) (P < 0.001). In this study, there was no significant difference between the diabetic and nondiabetic groups in respect to admission systolic blood pressure (152.5 ± 28.1 vs. 148.6 ± 27.3, P > 0.05) and diastolic blood pressure (87.9 ± 12.9 vs. 87.0 ± 11.4, P > 0.05). A similar result was observed by Jørgensen et al. that there was statistically no significant difference between the diabetic and nondiabetic groups in respect to systolic blood pressure (164 ± 33 vs. 163 ± 31, P > 0.65) and diastolic blood pressure (89 ± 18 vs. 90 ± 17, P> 0.45).[12]

The current study showed that admission SSS score was significantly less in the diabetic group than that of the nondiabetic group (21.1 [SD ± 10.1] versus. 28.1 [SD ± 11.6], P< 0.001). Smajlovic et al. were in agreement with this result that diabetic patients with stroke had more severe strokes than nondiabetic patients (SSS 20.5 vs. 39, P < 0.0001).[14] Smajlovic et al. also supported the present study that patients with diabetes had more severe strokes.[14] In this study, ischemic stroke in the diabetic group (83.0%) was significantly more than that of the nondiabetic group (59.6%) (P < 0.01). This result was in agreement with the study of Sarkar et al. that ischemic strokes were higher in the diabetic group (69%) as compared to the nondiabetic group (45.8%) which was significant.[13]

In the diabetic group, subtypes of hemorrhagic stroke were lobar (2 [25.0%]), basal ganglion (3 [37.5%]), thalamus (1 [12.5%]), and brain stem (2 [25.0%]), whereas in the nondiabetic group, subtypes of hemorrhagic stroke were lobar (5 [26.3%]), basal ganglion (7 [36.6%]), thalamus (5 [26.3%]), and brain stem (2 [10.5%]). In the diabetic group, subtypes of ischemic stroke were cortical infarcts (18 [46.2%]), subcortical infarcts (11 [28.2%]), brain stem (5 [12.8%]), cerebellum (3 [7.7%]), and unclassified (2 [5.1%]), whereas in the nondiabetic group, subtypes of ischemic stroke were cortical infarcts (15 [63.6%]), subcortical infarcts (8 [28.6%]), brain stem (2 [7.1%]), cerebellum (2 [7.1%]), and unclassified (1 [3.6%]). The difference between the two groups was statistically not significant (P > 0.05) similar to observation by Zafar et al. and Jørgensen et al.[8],[12]


  Conclusion Top


Stroke in the subjects with diabetes is different from stroke in subjects without diabetes in several aspects. The diabetic stroke patient is younger, ischemic stroke and severity is more, but hemorrhagic stroke is less in diabetic individuals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Alajbegovic A, Alajbegovic S. Stroke in diabetic patients in Cantonal Hospital Zenica. Med Arh 2009;63:194-6.  Back to cited text no. 1
    
2.
Strong K, Mathers C, Bonita R. Preventing stroke: Saving lives around the world. Lancet Neurol 2007;6:182-7.  Back to cited text no. 2
    
3.
Bontia R, Beaglehole R. Stroke prevention in poor countries, time for action. Stroke 2007;38:2871-2.  Back to cited text no. 3
    
4.
World Health Organization (WHO). The Atlas of Heart Disease and Stroke. Geneva, Switzerland: WHO; 2004.  Back to cited text no. 4
    
5.
Farooq MU, Majid A, Reeves MJ, Birbeck GL. The epidemiology of stroke in Pakistan: Past, present, and future. Int J Stroke 2009;4:381-9.  Back to cited text no. 5
    
6.
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3:e442.  Back to cited text no. 6
    
7.
Gordick PB, Sacco RL, Smith DB, Albert M, Mustone-Alexander L, Rader D, et al. Prevention of a first stroke: A review of guidelines and multidisciplinary consensus statement from the National Stroke Association. JAMA 1999;281:1112-20.  Back to cited text no. 7
    
8.
Zafar A, Shahid SK, Siddiqui M, Khan FS. Pattern of stroke in type 2 diabetic subjects versus non diabetic subjects. J Ayub Med Coll Abbottabad 2007;19:64-7.  Back to cited text no. 8
    
9.
UKPDS Group. Association on systolic blood pressure with macrovascular and microvascular complications of type 2 diabetic (UKPDA 36). BMJ 2000;321:412-9.  Back to cited text no. 9
    
10.
Grau AJ, Weimar C, Buggle F, Heinrich A, Goertler M, Neumaier S, et al. Risk factors, outcome, and treatment in subtypes of ischemic stroke: The German stroke data bank. Stroke 2001;32:2559-66.  Back to cited text no. 10
    
11.
Rodriguez BL, D'Agostino R, Abbott RD, Kagan A, Burchfiel CM, Yano K, et al. Risk of hospitalized stroke in men enrolled in the Honolulu Heart Program and the Framingham Study: A comparison of incidence and risk factor effects. Stroke 2002;33:230-6.  Back to cited text no. 11
    
12.
Jørgensen H, Nakayama H, Raaschou HO, Olsen TS. Stroke in patients with diabetes. The Copenhagen Stroke Study. Stroke 1994;25:1977-84.  Back to cited text no. 12
    
13.
Sarkar RN, Banerjee S, Basu A. Comparative evaluation of diabetic and non-diabetic stroke-effect of glycaemia on outcome. J Indian Med Assoc 2004;102:551-3.  Back to cited text no. 13
    
14.
Smajlovic D, Salihovic D, Ibrahimagic O, Sinanovic O, Burina A. Stroke in patients with diabetes mellitus: A hospital based study. Med Arh 2006;60:63-5.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Methods
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed387    
    Printed26    
    Emailed0    
    PDF Downloaded38    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]