Study Finds Opposite Directions for T2D Complications in Hospitalized Patients

Trends in treating the associated cardiovascular risks of type 2 diabetes (T2D) are headed in divergent directions, with in-hospital mortality for patients with strokes declining along with average length of stay (LoS), while stroke-related hospitalization costs have doubled, according to a new study.

With the prevalence and incidence of T2D increasing worldwide, researchers decided to examine trends in the United States for adult patients who were hospitalized with a stroke from 2005 to 2014 in a study published in Scientific Reports.

The study found the incidence of cases of stroke among patients with T2D increased from 17.4 per 100,000 adults to 20.0 (P < .001) from 2005-2014.

However, the age-adjusted mortality for those with hemorrhagic strokes decreased from 24.3% to 19.6% and falling from 3.23% to 2.48% as well for those with ischemic strokes (P < .001 for both); it did not change in TIA patients.

Meanwhile, average total charges per stay went the opposite direction, far outpacing inflation. Charges doubled over the 10-year period, increasing from $15,970 to $31,018 per day even as the median length of stay (LoS) decreased. LoS dropped from 4 [2-6] to 3 [2-6] days (P < .001).

Stroke is the leading cause of long-term disability and the fifth most common cause of mortality in the United States. Globally, the lifetime risk of stroke for adults ages 25 and older has nearly tripled from 9% in 1990 to 24.9% in 2016.

T2D is increasing for multiple reasons, including an aging population and a surge in obesity and sedentary lifestyles. Diabetes can accelerate atherosclerosis, making hyperglycemia an important risk factor for ischemic stroke. Diabetes also increases the risk of hemorrhagic stroke, heightened by hypertension and uncontrolled high blood sugar.

The researchers undertook the study on diabetes in patients with stroke amid evidence of mortality and hospitalization for some cardiovascular complications in T2D declining.

The trend in decreased mortality and incidence of stroke among diabetes patients mirrored the general population trend, the researchers said. In the United States, incidence has decreased but the prevalence has risen amid an aging population.

The incidence of stroke among diabetes patients increased significantly from 1.5 to 1.8 cases per 100,000 adults for hemorrhagic stroke and 11.3 to 14.3 per 100,000 US adults for ischemic stroke (P < .001 for both), according to the study. Transient ischemic attacks (TIAs) saw a significant decrease, however, dropping from 4.6 to 3.8 per 100,000 adults (P < .001).

The findings regarding TIAs were challenging, the researchers said, due to shifting definitions of what constitutes an attack. TIA was initially described as an event where neurological signs or symptoms resolve in less than 24 hours. The definition has shifted to a “tissue-based” one, describing TIA as a transient neurological event without clinical or radiographic evidence of an acute infarction. The redefinition is expected to account for reducing the annual incidence of TIAs. Trends are shifting downward regarding hospitalizations for TIAs as more patients are treated and released from the emergency room as stroke management evolves.

The prevalence of diabetes among all stroke patients increased gradually from 28.1% to 35.5% between 2005 and 2014 (P < .001). Analysis of a weighted sample showed 66.1% with ischemic stroke, 24.6% hemorrhagic stroke, and 9.3% with transient ischemic attacks (TIAs).

“In the future, we expected that widespread risk factor screening, coupled with aggressive primary and secondary prevention measures, will continue to reduce the burden of stroke, thus decreasing the burden of stroke-related disability in diabetic patients,” the authors wrote.

Reference

Tabbalat A, Dargham S, Al Suwaidi J., et al. Mortality and socio-economic outcomes among patients hospitalized for stroke and diabetes in the US: a recent analysis from the National Inpatient Sample. Sci Rep (2021);11: 8204. doi:10.1038/s41598-021-87320-w