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Increased risk of ischemic stroke after hyperosmolar hyperglycemic state: a population-based follow-up study.
PLoS One. 2014; 9(4):e94155.Plos

Abstract

BACKGROUND

Although much attention has been focused on the association between chronic hyperglycemia and cerebrovascular diseases in type 2 diabetes mellitus (DM) patients, there is no data regarding the risk of ischemic stroke after a hyperosmolar hyperglycemic state (HHS) attack. The objective of this study was to investigate the risk of ischemic stroke in type 2 DM patients after an HHS attack.

METHODS

From 2004 to 2008, this retrospective observational study was conducted on a large cohort of Taiwanese using Taiwan's National Health Insurance Research Database (NHIRD). We identified 19,031 type 2 DM patients who were discharged with a diagnosis of HHS and 521,229 type 2 DM patients without an HHS diagnosis. Using the propensity score generated from logistic regression models, conditional on baseline covariates, we matched 19,031 type 2 DM patients with an HHS diagnosis with the same number from the comparison cohort. The one-year cumulative rate for ischemic stroke was estimated using the Kaplan-Meier method. After adjusting covariates, Cox proportional hazard regression was used to compute the adjusted one-year rate of ischemic stroke.

RESULTS

Of the patients sampled, 1,810 (9.5%) of the type 2 DM patients with HHS and 996 (5.2%) of the comparison cohort developed ischemic stroke during the one-year follow-up period. After adjusting for covariates, the adjusted HR for developing ischemic stroke during the one-year follow-up period was 1.8 (95% C.I., 1.67 to 1.95, P<0.001) for type 2 DM patients with HHS compared with those without HHS.

CONCLUSION

Although DM is a well-recognized risk factor for atherosclerosis, type 2 DM patients that have suffered a HHS attacks are at an increased risk of developing ischemic stroke compared with those without HHS.

Authors+Show Affiliations

Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.Division of Neurology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan.Division of Metabolism and Endocrinology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan.School of Medicine, Tzu Chi University, Hualian, Taiwan; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan.Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.Division of Metabolism and Endocrinology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualian, Taiwan.School of Medicine, Tzu Chi University, Hualian, Taiwan; Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; Department of Education, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; Center for Clinical Epidemiology and Biostatistics, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24714221

Citation

Wang, Jen-Yu, et al. "Increased Risk of Ischemic Stroke After Hyperosmolar Hyperglycemic State: a Population-based Follow-up Study." PloS One, vol. 9, no. 4, 2014, pp. e94155.
Wang JY, Wang CY, Huang YS, et al. Increased risk of ischemic stroke after hyperosmolar hyperglycemic state: a population-based follow-up study. PLoS One. 2014;9(4):e94155.
Wang, J. Y., Wang, C. Y., Huang, Y. S., Chen, P. F., Huang, K. Y., Chou, P., Lian, W. C., & Lee, C. C. (2014). Increased risk of ischemic stroke after hyperosmolar hyperglycemic state: a population-based follow-up study. PloS One, 9(4), e94155. https://doi.org/10.1371/journal.pone.0094155
Wang JY, et al. Increased Risk of Ischemic Stroke After Hyperosmolar Hyperglycemic State: a Population-based Follow-up Study. PLoS One. 2014;9(4):e94155. PubMed PMID: 24714221.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased risk of ischemic stroke after hyperosmolar hyperglycemic state: a population-based follow-up study. AU - Wang,Jen-Yu, AU - Wang,Cheng-Yi, AU - Huang,Yung-Sung, AU - Chen,Pin-Fan, AU - Huang,Kuang-Yung, AU - Chou,Pesus, AU - Lian,Wei-Cheng, AU - Lee,Ching-Chih, Y1 - 2014/04/08/ PY - 2013/10/03/received PY - 2014/03/11/accepted PY - 2014/4/10/entrez PY - 2014/4/10/pubmed PY - 2015/1/7/medline SP - e94155 EP - e94155 JF - PloS one JO - PLoS One VL - 9 IS - 4 N2 - BACKGROUND: Although much attention has been focused on the association between chronic hyperglycemia and cerebrovascular diseases in type 2 diabetes mellitus (DM) patients, there is no data regarding the risk of ischemic stroke after a hyperosmolar hyperglycemic state (HHS) attack. The objective of this study was to investigate the risk of ischemic stroke in type 2 DM patients after an HHS attack. METHODS: From 2004 to 2008, this retrospective observational study was conducted on a large cohort of Taiwanese using Taiwan's National Health Insurance Research Database (NHIRD). We identified 19,031 type 2 DM patients who were discharged with a diagnosis of HHS and 521,229 type 2 DM patients without an HHS diagnosis. Using the propensity score generated from logistic regression models, conditional on baseline covariates, we matched 19,031 type 2 DM patients with an HHS diagnosis with the same number from the comparison cohort. The one-year cumulative rate for ischemic stroke was estimated using the Kaplan-Meier method. After adjusting covariates, Cox proportional hazard regression was used to compute the adjusted one-year rate of ischemic stroke. RESULTS: Of the patients sampled, 1,810 (9.5%) of the type 2 DM patients with HHS and 996 (5.2%) of the comparison cohort developed ischemic stroke during the one-year follow-up period. After adjusting for covariates, the adjusted HR for developing ischemic stroke during the one-year follow-up period was 1.8 (95% C.I., 1.67 to 1.95, P<0.001) for type 2 DM patients with HHS compared with those without HHS. CONCLUSION: Although DM is a well-recognized risk factor for atherosclerosis, type 2 DM patients that have suffered a HHS attacks are at an increased risk of developing ischemic stroke compared with those without HHS. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/24714221/Increased_risk_of_ischemic_stroke_after_hyperosmolar_hyperglycemic_state:_a_population_based_follow_up_study_ L2 - https://dx.plos.org/10.1371/journal.pone.0094155 DB - PRIME DP - Unbound Medicine ER -