Cerebrovascular Disease

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People with diabetes are at increased risk for cerebrovascular events (83). The estimated relative risk for patients with diabetes was initially reported to be 2.5-fold to 3.5-fold greater in diabetic patients that were aged 45 to 74 in the Framingham study (83). It was later modified to 1.4 for diabetic men and 1.72 for diabetic women after adjusting for other known risk factors (84). Diabetes was found to be responsible for 16 percent of stroke deaths in men and 33 percent in women, in a study reviewing stroke mortality (85). In a stroke-survival study, the 30-day survival rate was 89 percent in men and 79 percent in women; one-year survival was 79 percent for men and 64 percent for women (86).

There may be specific patterns of stroke associated with diabetic patients. Review of a prospective, community-based registry showed that diabetes mellitus was associated with a lower relative prevalence of intracerebral hemorrhage (OR [95 percent CI]:0.63 (0.45 to 09.9); p = 0.022), higher relative prevalence of subcortical infarction (1.34 [1.11 to 1.62]; p = 0.009), and higher relative frequency of small-vessel disease (1.78 [1.31 to 3.82]; p = 0.012) and large-artery disease (2.02 [1.31 to 2.02] p = 0.002) (87). There was, however, no significant difference in the level of moderate to severe deficit on admission (31.1 percent versus 31.6 percent; p = 0.4) and poor functional outcome at one month (14.1 percent versus 15.3 percent; p = 0.24) when comparing patients with diabetes mellitus to patients who do not have the disease (87). A European study evaluating diabetes in 937 patients revealed that patients with diabetes were more likely to have limb weakness (p < 0.02), dysarthria (p < 0.001), ischemic stroke (p << 0.001), and lacunar cerebral infarction (p = 0.03) (88). Handicap (Rankin scale) disability (Barthel Index) was significantly higher in patients with diabetes (p = 0.005 and p = 0.016) (88).

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