Study Of Risk Factors For Recurrence Of Acute Ischemic Stroke In Elderly Patients With Type 2 Diabetes Mellitus

Objective:Type 2 diabetes mellitus（T2DM）is a high risk factor for cardiovascular and cerebrovascular diseases.Relevant studies have shown that T2 DM is closely associated with acute ischemic stroke（AIS）recurrence,but the cause and mechanism of recurrent ischemic stroke（RIS）remain unclear.This study aimed to investigate the associated risk factors and predictors of acute ischemic stroke recurrence in elderly patients with type 2 diabetes mellitus.Methods:In this study,a total of 267 elderly AIS patients who met the inclusion and exclusion criteria,attending the Department of general medicine,Department of Neurology,and interventional vascular unit of the second people’s Hospital of Hefei from July 2019 to September 2021,were randomly selected and divided into case and control groups based on the presence or absence of a history of T2 DM.Because 3 patients were lost to follow-up and finally included in the statistical results,152 in the case group（elderly T2 DM + AIS patients）and 112 in the control group（elderly AIS patients）.Clinical data of patients were collected: basic information included gender,age,height,weight;Disease information included history of diabetes mellitus,hypertension,coronary heart disease,hyperlipidemia as well as other diseases;Lifestyle habits included history of smoking,alcohol consumption and exercise.In addition,the relevant vital signs and biochemical indexes of patients on admission were collected,including the mean diastolic blood pressure（mdbp）and mean systolic blood pressure（MSBP）after 72 h of admission;Blood samples were collected by fasting,72 hours after admission,and information on serum uric acid（UA）,serum homocysteine（Hcy）,serum creatinine（SCR）,blood urea nitrogen（BUN）,glycated hemoglobin A1c（Hb A1c）,serum total cholesterol（TC）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C）,and triglycerides（TG）was collected;Patients’ blood glucose levels were monitored by fingerstick glucose monitoring beginning 72 hours after admission,with monitoring time points: fasting,before lunch,before dinner,2 hours after three meals,and at bedtime,continuously monitored for 4 days,and averaged.Data related to blood glucose variability,including standard deviation of blood glucose levels（SDBG）,mean amplitude of blood glucose excursion（MAGE）,mean postprandial glucose excursion（mmppge）,maximum amplitude of blood glucose excursion（lage）and coefficient of variation（CV）,were calculated based on the patients’ fingertip blood glucose monitoring results.Finally,recurrent ischemic stroke events were confirmed in all enrolled patients through home visits,telephone follow-up visits,and outpatient clinic revisits by a dedicated person over a 90 day period.Patients were subdivided into recurrence and no recurrence groups according to the presence or absence of recurrent events,the univariate differences of the indicators were compared between the two groups,logistic regression model was applied for the significantly associated indicators to analyze the associated risk factors for ischemic stroke recurrence,and finally ROC curve analysis was applied to explore the predictive value of the above risk factors for ischemic stroke recurrence in elderly T2 DM patients with AIS.Results:1.Among 152 T2 DM + AIS patients in this study,38（25.00%）had AIS recurrence within 90 days cumulatively.Of the 112 AIS patients,14（12.50%）had a cumulative AIS recurrence within 90 days.Pearson chi square test showed that history of T2 DM was positively associated with AIS recurrence.2.The intergroup contrasts for T2 DM + AIS relapsed and non relapsed groups showed that UA,Hcy,SCR,FBG,2h PBG,as well as increased glycemic variability were positively correlated with RIS.3.After correction for Scr,FBG,and 2h PBG factors,logistic analysis and ROC curve analysis showed that UA and Hcy as well as MAGE,SDBG,m PPGE,and CV in the variability of blood glucose were independent risk factors for the development of RIS in elderly patients with T2 DM complicated with ischemic stroke.All of these indicators had better clinical predictive values.Conclusion:In elderly patients,high blood UA levels,Hcy levels,and glycemic variability of T2 DM are high-risk factors for AIS recurrence.Among them,UA level,Hcy level,MAGE,SDBG,m PPGE and CV had predictive value for recurrent ischemic stroke and were clinically significant,which may provide a new idea for the prediction of RIS in elderly T2 DM patients with acute ischemic stroke.