Which Diabetes Type Has Higher Stroke Risk?

TOPLINE:

Individuals with type 1 diabetes had more than twice the risk for ischaemic stroke and an 88% higher risk for haemorrhagic stroke than control individuals, whereas those with type 2 diabetes had a 37% higher risk for ischaemic stroke, with no significant impact on the risk for haemorrhagic stroke.

METHODOLOGY:

• This Sweden-wide cohort study included 47,720 individuals with type 1 diabetes (mean age, 34.4 years; 44.8% women) and 686,158 individuals with type 2 diabetes (mean age, 65.3 years; 43.3% women) from the National Diabetes Register (2005-2019), matched to 143,160 and 2,058,474 diabetes-free control individuals, respectively, from the Total Population Register.
• Data on baseline demographics, comorbidities, medications, laboratory values, and outcomes were obtained from multiple national registers.
• The primary outcome was the time to the first ischaemic or haemorrhagic stroke after diabetes diagnosis, with follow-up until death or December 31, 2022.

TAKEAWAY:

• Individuals with type 1 diabetes had a higher risk for ischaemic stroke (hazard ratio [HR], 2.54; 95% CI, 2.36-2.73) and haemorrhagic stroke (HR, 1.88; 95% CI, 1.57-2.26) than control individuals.
• Individuals with type 2 diabetes had a higher risk for ischaemic stroke (HR, 1.37; 95% CI, 1.35-1.38) than control individuals, but no significant association was found between type 2 diabetes and the risk for haemorrhagic stroke (HR, 0.99; 95% CI, 0.96-1.02).
• Higher A1c levels were linked to an increased risk for ischaemic stroke in both diabetes types.
• Individuals with type 1 diabetes had a significantly higher risk for haemorrhagic stroke at A1c levels > 52 mmol/mol, whereas those with type 2 diabetes had a significantly higher risk only at A1c levels > 72 mmol/mol.

IN PRACTICE:

“These findings highlight the need for targeted stroke prevention strategies in individuals with diabetes,” the authors wrote.”The distinct stroke risk profiles between type 1 and type 2 diabetes emphasise the importance of considering diabetes types when developing clinical interventions and prevention efforts,” they added.

SOURCE:

The study was led by Anastasios Mavridis, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. It was published online on March 13 in Neurology.

LIMITATIONS:

The study’s limitations included the use of only baseline characteristics, without accounting for changes in medications or comorbidities over time, which may have introduced bias. Cardiovascular risk factors were available only for individuals with diabetes, limiting their inclusion in adjusted models. The study’s observational nature prevented the establishment of causation, and unmeasured confounders may have influenced the results.

DISCLOSURES:

The study was funded by Sahlgrenska University Hospital funds, the Swedish state, the Swedish Stroke Association, the Swedish Brain Foundation, the Winberg Foundation, and Promobilia. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.