Incidence of stroke according to presence of diabetic nephropathy and severe diabetic retinopathy in patients with type 1 diabetes.

Abstract

OBJECTIVE:

Type 1 diabetes is associated with a markedly increased risk of stroke, but only a few studies on the incidence of stroke in type 1 diabetes exist. Therefore, we assessed the incidence of stroke in patients with type 1 diabetes and studied the impact of diabetic nephropathy (DN) and severe diabetic retinopathy (SDR) on this risk.

RESEARCH DESIGN AND METHODS:

We studied 4,083 patients with type 1 diabetes from the Finnish Diabetic Nephropathy Study. Mean age was 37.4 ± 11.8 years, duration of diabetes was 21.6 ± 12.1 years, and 52% were men. Strokes were identified from medical records, death certificates, and the National Hospital Discharge Register and classified based on medical files and brain images.

RESULTS:

During 36,680 person-years of follow-up, 149 (4%) patients suffered an incident stroke (105 infarctions and 44 hemorrhages). Of the infarctions, 58 (55%) were lacunar. The incidence of stroke, cerebral infarction, and cerebral hemorrhage was 406 (95% CI 344-477), 286 (234-347), and 120 (87-161) per 100,000 person-years, respectively. In an adjusted analysis, microalbuminuria increased the risk of stroke with a hazard ratio (HR) of 3.2 (1.9-5.6), macroalbuminuria 4.9 (2.9-8.2), and end-stage renal disease 7.5 (4.2-13.3), and SDR increased the risk with an HR of 3.0 (1.9-4.5). The risk of cerebral infarction, cerebral hemorrhage, and lacunar infarction increased in a similar manner. The proportion of lacunar versus nonlacunar infarction did not change across DN groups.

CONCLUSIONS:

The presence of SDR and DN, independently, increases the risk of stroke, cerebral infarction, and cerebral hemorrhage in patients with type 1 diabetes.

• Authors: Stefanie Hägg, Lena M Thorn, Jukka Putaala, Ron Liebkind, Valma Harjutsalo, Carol M Forsblom, Daniel Gordin, Turgut Tatlisumak, Per-Henrik Groop, FinnDiane Study Group
• Journal: Diabetes care (Diabetes Care) Vol. 36 Issue 12 Pg. 4140-6 (Dec 2013) ISSN: 1935-5548 [Electronic] United States
• PMID: 24101700 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Brain (diagnostic imaging, pathology)
• Diabetes Mellitus, Type 1 (blood, complications, diagnosis)
• Diabetic Nephropathies (complications, diagnosis)
• Diabetic Retinopathy (complications, diagnosis)
• Female
• Finland
• Follow-Up Studies
• Humans
• Incidence
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Stroke (diagnosis, epidemiology, etiology)
• Tomography, X-Ray Computed