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. 2024 Dec;61(12):1543-1552.
doi: 10.1007/s00592-024-02318-w. Epub 2024 Jul 1.

Diabetes mellitus in stroke unit: prevalence and outcomes-the Verona acute coronary syndrome and stroke in diabetes outcome (VASD-OUTCOME) study

Marco Dauriz  1 , Alessandro Csermely  2 , Lorenza Santi  2 , Elena Tregnaghi  2 , Alberto Grotto  2 , Tiziano Lucianer  2 , Anna Altomari  2 , Elisabetta Rinaldi  2 , Stefano Tardivo  3 , Bruno Bonetti  4 , Enzo Bonora  5
Affiliations

Diabetes mellitus in stroke unit: prevalence and outcomes-the Verona acute coronary syndrome and stroke in diabetes outcome (VASD-OUTCOME) study

Marco Dauriz et al. Acta Diabetol. 2024 Dec.

Abstract

Background: Cerebrovascular accidents (CVA) represent a major complication in diabetes (DM). Real-life evidence as to whether modern management of CVA and DM have softened this relationship is limited. Therefore, we estimated prevalence and impact of DM on in-hospital survival and complications in a contemporary cohort of subjects with CVA.

Methods: We retrospectively evaluated the records of 937 patients admitted for CVA at the Stroke Unit of Verona University Hospital during a 3-year period. Pre-existing or de novo DM was ascertained by prior diagnosis, glucose-lowering therapy at admission/discharge or admittance plasma glucose ≥ 200 mg/dL. Multiple regressions were applied to test DM as predictor of in-hospital mortality, complications (composite of infections, cardio- and cerebrovascular complications, major bleeding and pulmonary complications), duration and costs of hospitalization.

Results: Diabetes prevalence was 21%, of which 22% de novo diagnoses. Compared to non-DM, diabetic individuals were older and carried an increased burden of cardiovascular risk factors. Compared to known DM, de novo DM individuals were younger, had higher admittance plasma glucose and poorer cardiovascular comorbidities. Overall, DM versus non-DM individuals did not show significantly increased risk of death (14.0 vs. 9.3%; crude-OR 1.59 95% CI 0.99-2.56). Controlling for confounders did not improve significance. DM resulted independent predictor for in-hospital complications (36.2% vs. 26.9%; adj-OR 1.49, 1.04-2.13), but not for duration and costs of hospitalization.

Conclusion: DM frequently occurs in patients admitted for stroke and carries an excess burden of adverse in-hospital complications, urgently calling for strategies to anticipate DM diagnosis and tailored treatment in high-risk individuals.

Keywords: Complications; Hospitalization costs; In-hospital mortality; Stroke; Type 2 diabetes mellitus.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval: The VASD-OUTCOME Study (1765CESC) was conducted in accordance with the Declaration of Helsinki and was approved by the local Ethics Committee of the Azienda Ospedaliera Universitaria Integrata di Verona (Protocol No. 25312; April 26, 2018). Informed consent: Due to the retrospective nature of the study no informed consent was collected from patients.

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