National Trends in the Achievement of Recommended Strategies for Stroke Prevention in U.S. Adults With Type 2 Diabetes, 2001-2018

Abstract

Objective: To assess the national prevalence of and trends in achieving current guideline-recommended treatment goals and pharmacotherapies for primary and secondary prevention of stroke among U.S. adults with type 2 diabetes (T2D).

Research design and methods: We performed serial cross-sectional analyses in 4,834 adults aged ≥45 years with T2D who participated in the 2001-2018 National Health and Nutrition Examination Survey. With stratification by stroke history, we estimated the proportion of adults with T2D who achieved current guideline-recommended strategies for stroke prevention. Preventive strategies for stroke were benchmarked against diabetes care and cardiovascular risk reduction guidelines.

Results: Overall in 2001-2018, among those without stroke history, the proportion who achieved primary stroke prevention strategies ranged from 8.4% (95% CI 6.8-10.1) for aspirin/clopidogrel treatment in those with a higher cardiovascular disease risk to 80.5% (78.8-82.2) for nonsmoking. Among those with stroke history, the proportion who achieved secondary stroke prevention strategies ranged from 11.8% (8.7-14.8) for weight control to 80.0% (74.9-84.9) for glycemic control. From 2001 to 2018, among those without stroke history, there was a significant increase in statin therapy (Ptrend < 0.0001), smoking abstinence (Ptrend = 0.01), and ACE inhibitor/angiotensin receptor blocker treatment for hypertension (Ptrend = 0.04) but a substantial decline in weight control (Ptrend < 0.001). Among those with stroke history, only statin therapy (Ptrend = 0.01) increased significantly over time.

Conclusions: During 2001-2018, the achievement of some current guideline-recommended strategies for stroke prevention among U.S. adults with T2D improved but remains a challenge overall. Efforts are needed to improve implementation of strategies for stroke prevention in this population.

Figure 1

Trends in achievement of stroke prevention strategies (weighted) among U.S. adults with T2D by stroke history during 2001–2018. A: Well-controlled HbA_1c. B: Well-controlled BP. C: Statin treatment. D: Treatment with aspirin/clopidogrel in patients with a 10-year ASCVD risk >10%. E: Not smoking. F: Well-controlled BMI. G: Treatment with ACE inhibitor/ARB in patients with hypertension. H: Treatment with ACE inhibitor/ARB in patients with hypertension and albuminuria. Dashed lines, patients with stroke history; solid lines, patients without stroke history. Horizontal lines and bars indicate 95% CIs. ADA, American Diabetes Association; AHA, American Heart Association; ASA, American Stroke Association.