Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
Atherosclerosis. 2017 Oct;265:87-92. doi: 10.1016/j.atherosclerosis.2017.08.017. Epub 2017 Aug 22.
BACKGROUND & AIMS: The relationship between stroke and diabetes is not completely understood. This study evaluated diabetes risk and post-diabetes adverse events in patients with stroke.
We identified 10,255 adults, newly diagnosed with stroke from 2000 to 2005, using the Taiwan's National Health Insurance Research Database. A comparison cohort of 41,020 adults without stroke was randomly selected from the same dataset, frequency matched by age and sex. Diabetes events from 2000 to 2013 were ascertained from medical claims. Adjusted hazard ratios (HRs) and 95% CIs were calculated for diabetes associated with stroke. A nested cohort study of 33,437 patients with inpatient care for diabetes between 2008 and 2013 was conducted to calculate the adjusted odds ratios (ORs) and 95% CIs for adverse events after diabetes, in patients with and without stroke.
During 489,561 person-years of follow-up, there were 10,742 newly diagnosed diabetes cases. The incidence of diabetes for people with and without stroke was 43.9 and 17.8 per 1000 person-years, respectively (p < 0.0001). Compared to that for people without stroke, the adjusted HR for diabetes was 2.69 (95% CI 2.56-2.82) for stroke patients. The ORs of post-diabetes pneumonia, urinary tract infection, and mortality associated with stroke were 1.35 (95% CI 1.17-1.55), 1.52 (95% CI 1.36-1.70), and 1.71 (95% CI 1.27-2.29), respectively.
We provide evidence that the consequences of stroke are not limited to the neurological defect, but evoke diabetes and a plethora of associated medical, psychological and social impacts the physician must be strongly aware of if evaluating and treating stroke patients.
卒中与糖尿病之间的关系尚未完全阐明。本研究评估了卒中患者的糖尿病发病风险和糖尿病后不良事件。
我们利用台湾全民健康保险研究数据库，于 2000 年至 2005 年识别出 10255 名新诊断为卒中的成年人。从同一数据集中随机选择了 41020 名无卒中的成年人作为对照组，年龄和性别与卒中组相匹配。从医疗索赔中确定 2000 年至 2013 年的糖尿病事件。计算卒中与糖尿病相关的调整后的风险比（HR）和 95%置信区间（CI）。对 2008 年至 2013 年因糖尿病住院治疗的 33437 例患者进行嵌套队列研究，以计算卒中患者和无卒中患者糖尿病后不良事件的调整后比值比（OR）和 95%CI。
在 489561 人年的随访期间，新诊断出糖尿病 10742 例。有卒中患者和无卒中患者的糖尿病发病率分别为 43.9 和 17.8/1000 人年（p<0.0001）。与无卒中患者相比，卒中患者的糖尿病调整 HR 为 2.69（95%CI 2.56-2.82）。与无卒中患者相比，卒中患者的糖尿病后肺炎、尿路感染和死亡率的 OR 分别为 1.35（95%CI 1.17-1.55）、1.52（95%CI 1.36-1.70）和 1.71（95%CI 1.27-2.29）。
我们提供的证据表明，卒中的后果不仅限于神经缺陷，还会引发糖尿病以及一系列相关的医疗、心理和社会影响，医生在评估和治疗卒中患者时必须对此有深刻的认识。
