The Role of Diabetes Mellitus in the Severity of Ischemic Stroke: An Inpatient Study
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Abstract
Background: Diabetes mellitus (DM) is recognized as an important risk factor associated with ischemic stroke and unfavorable clinical outcomes. Persistent hyperglycemia and vascular dysfunction may contribute to increased neurological impairment among stroke patients. However, evidence regarding the relationship between DM and ischemic stroke severity in hospitalized patients in Indonesia remains limited.
Objective: This study aimed to determine the association between diabetes mellitus and the severity of ischemic stroke among hospitalized patients.
Methods: A cross-sectional observational study was conducted using retrospective medical record data from patients diagnosed with acute ischemic stroke at Jemursari Islamic Hospital Surabaya between January and April 2025. Diabetes mellitus status was identified from documented diagnosis, antidiabetic treatment history, or laboratory findings. Stroke severity was evaluated using the Modified Rankin Scale (mRS) and categorized into mild (mRS 1–2), moderate (mRS 3), and severe disability (mRS 4–5). Statistical analysis was performed using the Chi-square test, and the association strength was expressed as odds ratio (OR) with a 95% confidence interval (CI).
Results: A total of 46 patients were included in the study. Most participants presented with moderate-to-severe functional disability. Diabetes mellitus showed a significant association with ischemic stroke severity (p < 0.05). Patients with DM had a greater likelihood of developing moderate-to-severe stroke compared with non-diabetic patients (OR = 3.2; 95% CI: 1.1–9.4).
Conclusion: Diabetes mellitus was significantly associated with increased severity of ischemic stroke among hospitalized patients. These findings emphasize the importance of early identification and optimal glycemic management to reduce severe neurological and functional outcomes in ischemic stroke patients.
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References
American Diabetes Association Professional Practice Committee. (2024). 6. Glycemic goals and hypoglycemia: Standards of Care in Diabetes—2024. Diabetes Care, 47(Suppl. 1), S111–S125. https://doi.org/10.2337/dc24-S006
Banerjee, C., & Chimowitz, M. I. (2017). Stroke caused by atherosclerosis of the major intracranial arteries. Circulation Research, 120(3), 502–513. https://doi.org/10.1161/CIRCRESAHA.116.308441
Campbell, B. C. V., Khatri, P., Saver, J. L., et al. (2024). Advances in acute ischemic stroke management and implications for patients with diabetes. The Lancet Neurology, 23(2), 150–164.
Chen, R., Ovbiagele, B., & Feng, W. (2022). Diabetes and stroke: Epidemiology, pathophysiology, pharmaceuticals and outcomes. American Journal of Medicine, 135(7), 857–865. https://doi.org/10.1016/j.amjmed.2022.02.011
Climent, E., Rodriguez-Campello, A., Jiménez-Balado, J., et al. (2024). Acute-to-chronic glycemic ratio as an outcome predictor in ischemic stroke in patients with and without diabetes mellitus. Cardiovascular Diabetology, 23(1), 260. https://doi.org/10.1186/s12933-024-02260-9
Donnan, G. A., Fisher, M., Macleod, M., & Davis, S. M. (2008). Stroke. The Lancet, 371(9624), 1612–1623. https://doi.org/10.1016/S0140-6736(08)60694-7
Hastrup, S., Hedegaard, J. N., Andersen, G., Rungby, J., & Johnsen, S. P. (2024). Type 2 diabetes mellitus in patients with ischemic stroke: A nationwide study. Diabetic Medicine, 41(8), e15337. https://doi.org/10.1111/dme.15337
Jiang, Z., Wang, K., Duan, H., Li, H., & Zhang, L. (2024). Association between stress hyperglycemia ratio and prognosis in acute ischemic stroke: A systematic review and meta-analysis. BMC Neurology, 24(1), 3519. https://doi.org/10.1186/s12883-023-03519-6
Kementerian Kesehatan Republik Indonesia. (2018). Laporan Riskesdas 2018. Badan Penelitian dan Pengembangan Kesehatan, Kemenkes RI.
Kaynak, N., Kennel, V., Rackoll, T., Yilmaz, H., & Meisel, A. (2024). Impaired glucose metabolism and the risk of vascular events and mortality after ischemic stroke: A systematic review and meta-analysis. Cardiovascular Diabetology, 23(1), 413. https://doi.org/10.1186/s12933-024-02413-w
Kleindorfer, D. O., Towfighi, A., Chaturvedi, S., et al. (2021). 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline from the American Heart Association/American Stroke Association. Stroke, 52(7), e364–e467. https://doi.org/10.1161/STR.0000000000000375
Kleindorfer, D. O., Towfighi, A., Chaturvedi, S., Cockroft, K. M., Gutierrez, J., Lombardi-Hill, D., … American Heart Association Stroke Council. (2024). 2024 guideline for the primary prevention of stroke: A guideline from the American Heart Association/American Stroke Association. Stroke, 55(6), e175–e200. https://doi.org/10.1161/STR.0000000000000475
Li, W., Chen, Y., Tian, H., et al. (2021). Impact of diabetes mellitus on clinical outcomes of acute ischemic stroke patients: A systematic review and meta-analysis. Frontiers in Endocrinology, 12, 646970. https://doi.org/10.3389/fendo.2021.646970
O’Donnell, M. J., Chin, S. L., Rangarajan, S., et al. (2016). Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): A case-control study. The Lancet, 388(10046), 761–775. https://doi.org/10.1016/S0140-6736(16)30506-2
Powers, W. J., Rabinstein, A. A., Ackerson, T., et al. (2023). Update on the management of acute ischemic stroke: Scientific statement from the American Heart Association/American Stroke Association. Stroke.
Sacco, S., Foschi, M., Ornello, R., et al. (2024). Prevention and treatment of ischaemic and haemorrhagic stroke in people with diabetes mellitus: A focus on glucose control and comorbidities. Diabetologia, 67, 1192–1205. https://doi.org/10.1007/s00125-024-06146-z
World Health Organization. (2018). Global health estimates 2018: Disease burden by cause, age, sex, by country and by region, 2000–2018. WHO
Yang, P., Li, Z., Zhou, Y., et al. (2023). Hyperglycemia and functional outcomes in acute ischemic stroke: A nationwide cohort study. Diabetes & Metabolism, 49(2), 101376. https://doi.org/10.1016/j.diabet.2022.101376
Nurlisa Naila Aulia