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Multicenter Study
. 2013 Dec;36(12):4140-6.
doi: 10.2337/dc13-0669. Epub 2013 Oct 7.

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

Stefanie Hägg  1 , Lena M Thorn, Jukka Putaala, Ron Liebkind, Valma Harjutsalo, Carol M Forsblom, Daniel Gordin, Turgut Tatlisumak, Per-Henrik Groop; FinnDiane Study Group
Collaborators, Affiliations
Multicenter Study

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

Stefanie Hägg et al. Diabetes Care. 2013 Dec.

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.

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Figures

Figure 1
Figure 1
Proportion of lacunar and nonlacunar infarction of the total infarctions in patients with neither complication, only SDR, only DN, or both complications. The number in the bars represents the number of patients in that group.
See this image and copyright information in PMC

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