Functional outcome of ischemic stroke in diabetics

Abstract

Objective: Objective was to determine whether the outcome of ischemic stroke is different or not in diabetics than nondiabetics. Study Design: Prospective observational. analytical study Study place and Duration; It was conducted in medical unit-2 Bahawal Victoria Hospital, affiliated with Quaid-e-Azam Medical College Bahawalpur from October I, 2004 to September 30. 2005. Patients and methods: 132 patients of ischemic stroke, confirmed by CT scan, were enrolled during one year study period. The patients of hemorrhagic stroke, TlA, focal deficits of non-vascular origin and infratentorial lesions were excluded. Patients were devided into two groups; diabetics and nondiabetics and were studied regarding their in hospital outcome according to the modified Rankin Scale. The variables applied were age, sex, hypertension and type of infarct (lacunar/cerebral). Results: Out of 132 ischemic stroke patients 36 (27%) were diabetics and 96 were nondiabetics. Hjipertension was present in 83 (62%). Overall mortality wa s 11.3%. Mortality was significantly more frequent in diabetics than nondiabetics (16.6% Vs 9.3% p<0.05). Disability was also more frequent in diabetics (25% Vs 13.5% p<0.05). In diabetic group good recovery (8.8% Vs 12.5%) as well as partial recovery (50% Vs 64.5%) was less frequent. Patients <40 years were few in number with good recovery in both diabetics as well as nondiabetics. Diabetics of 40-60 years were found to have significantly high number of deaths (15.3% Vs 7% p<0.05) and disability (15.3% Vs 10.7% p<0.05) than non-diabetics. Similar pattern was seen in patients >60 years. Increasing age was found to be associated with poor outcome in both the groups but poorer in diabetics. Sex did not discriminate the poor outcome in diabetics. The presence of hypertension worsened the out come in both the groups but more in the diabetic group both in term of mortality (20.8% Vs 11.8% p<0.05) as well as disability (33.3% Vs 15.2% p<0.05). Lacunar infarct was found in few patient with good prognosis while cere bral infarct was associated with poor prognosis and put the diabetics at higher risk in term of mortality (17.6% Vs 9.8% p<0.05) as well as disability (26.4% Vs 14.2% p<0.05). Conclusion: Diabetes Mellitus is associated with poor outcome of ischemic stroke patients both in terms of mortality and morbidity during acute hospitalization. Hypertension. increasing age and large infarct size further worsens the outcome.