The effects of micro- and macrovascular diabetic complications on ischemic stroke in patients with type 2 diabetes mellitus

Objectives: The present study aimed to examine the effects of diabetes complications on the ischemic stroke risk among patients with type 2 diabetes mellitus (T2DM). Patients and methods: The medical records of all patients (n=5,468) who were admitted to a tertiary care hospital between January 1, 2021, and June 1, 2022, were retrospectively reviewed. Of 911 patients diagnosed with T2DM for at least two years, 37 patients with a history of hemorrhagic cerebrovascular disease were excluded. Consequently, the study was conducted with 874 patients (460 males, 414 females; mean age: 65.5±12.1 years; range, 39 to 92 years) with T2DM. Demographic data, presence of chronic disease other than diabetes, duration of diabetes, retinopathy, nephropathy, peripheral arterial disease, and diabetes medications were recorded. The patients were divided into two groups: those with and without a history of ischemic stroke. The two groups were compared in terms of demographic characteristics and diabetes complications. Results: The prevalence of ischemic stroke was 18.6% (n=163). Patients with ischemic stroke were older than those without ischemic stroke, had longer diabetes durations, and had higher rates of hypertension, hyperlipidemia, and insulin use (p=0.001, p<0.001, p<0.001, p<0.001, and p<0.001, respectively). Diabetic retinopathy (41.7%), diabetic nephropathy (27.6%), and peripheral arterial disease (16.6%) were more commonly observed among patients with ischemic stroke compared to the others. Examining the parameters differing between the groups, diabetes duration, hypertension, insulin use, and peripheral arterial disease were found to be independent risk factors for ischemic stroke (p<0.001, p<0.001, p=0.001, and p=0.001, respectively). Conclusion: Examining the relationship between diabetes complications and ischemic stroke risk from a broader perspective, the present study provided important implications for clinical management. Large-scale studies are needed in the future.