Chen Y-L, Weng S-F, Yang C-Y, Wang J-J, Tien K-J
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi-Mei Medical Center, Chia-Li Branch, Tainan, Taiwan.
Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
Diabetes Metab. 2017 Jun;43(3):223-228. doi: 10.1016/j.diabet.2016.11.003. Epub 2017 Jan 24.
To investigate the long-term risk of stroke in type 2 diabetes (T2D) patients with previous episodes of diabetic ketoacidosis (DKA).
This retrospective nationwide population-based cohort study was conducted using Taiwan's National Health Insurance database. Claims data from 2000 to 2002 were extracted for 3572 T2D patients with DKA and 7144 controls matched for age, gender, diabetes complications severity index, frequency of clinical visits and baseline comorbidities. Patients with type 1 diabetes (T1D), identified by glucagon C-peptide stimulation or glutamic acid decarboxylase (GAD) antibody blood tests and possession of a catastrophic illness certificate were excluded. All patients were tracked until a new stroke diagnosis, death or the end of 2011.
Of the 3572 selected patients, 270 with DKA and 404 of the 7144 controls were diagnosed with a new stroke, giving an incidence rate ratio (IRR) of 1.56 (95% CI: 1.34-1.82; P<0.0001). DKA patients had a higher risk of ischaemic stroke than those without DKA (IRR: 1.62, 95% CI: 1.34-1.96; P<0.0001), and DKA patients with hypertension and hyperlipidaemia were at even greater risk of stroke. Also, DKA patients were at particular risk for stroke during the first half-year following DKA diagnosis. After adjusting for patient characteristics and comorbidities, these patients were 1.55 times more likely to have a stroke than those without DKA (95% CI: 1.332-1.813, P<0.0001).
T2D patients with previous DKA have a higher risk of stroke, especially ischaemic strokes.
调查既往有糖尿病酮症酸中毒（DKA）发作史的2型糖尿病（T2D）患者发生中风的长期风险。
本项回顾性全国性基于人群的队列研究使用了台湾地区国民健康保险数据库。提取了2000年至2002年期间3572例患有DKA的T2D患者以及7144例在年龄、性别、糖尿病并发症严重程度指数、临床就诊频率和基线合并症方面匹配的对照的数据。通过胰高血糖素C肽刺激试验或谷氨酸脱羧酶（GAD）抗体血液检测确诊为1型糖尿病（T1D）且持有重大疾病证明的患者被排除。所有患者均被追踪至新中风诊断、死亡或2011年底。
在3572例入选患者中，270例患有DKA者和7144例对照中的404例被诊断为新发中风，发病率比（IRR）为1.56（95%可信区间：1.34 - 1.82；P < 0.0001）。患有DKA的患者比未患DKA的患者发生缺血性中风的风险更高（IRR：1.62，95%可信区间：1.34 - 1.96；P < 0.0001），患有高血压和高脂血症的DKA患者中风风险更高。此外，DKA患者在DKA诊断后的上半年发生中风风险尤其高。在对患者特征和合并症进行校正后，这些患者发生中风可能性是未患DKA者1.55倍（95%可信区间：1.332 - 1.813，P < 0.0001）。
既往有DKA发作史的T2D患者中风风险更高，尤其是缺血性中风风险。
