Hypoglycemic events linked to subsequent stroke risk in diabetes
Medicare patients with diabetes who had a hypoglycemic event had higher odds of a subsequent acute ischemic stroke. Risk was highest on the day after the event and decreased with time but persisted for 30 days, the case-crossover study found.
Patients with diabetes who have a hypoglycemic event may be at higher risk for acute ischemic stroke, according to a recent study.
Researchers used Medicare data from inpatient and outpatient settings, EDs, and subacute nursing facilities to conduct a case-crossover study investigating whether hypoglycemia was associated with subsequent acute ischemic stroke. Case periods of 1, 3, 7, 14, and 30 days before the index encounter for acute ischemic stroke were compared with control periods of equal length exactly one year earlier, with patients serving as their own controls. The results were published Nov. 22 by Stroke.
Overall, 237,667 index admissions for acute ischemic stroke in patients with diabetes occurred in the study population during the study period (Jan. 1, 2016, to Dec. 31, 2019). Of these, 50.6% were patients ages 75 years and older, 50.2% were male, 52.2% had hypertension, 35.4% smoked, 28.3% had atrial fibrillation or flutter, and 65.2% had hypercholesterolemia. Odds of acute ischemic stroke were higher after experiencing hypoglycemia, with highest risk immediately on the first day after the hypoglycemic event (odds ratio, 3.694 [95% CI, 2.694 to 5.065]; P<0.0001) and gradually decreasing as the case-control period lengthened. The risk was lowest but still significant at a case-control interval of 30 days (odds ratio, 2.345 [95% CI, 2.179 to 2.523]; P<0.0001).
The researchers noted that they weren't able to measure the severity of hypoglycemic events or include hypoglycemic events that occurred at home. They also pointed out that the study involved mostly older patients, among other limitations.
“In conclusion, our research suggests a strong association between hypoglycemic events and stroke among patients with diabetes, with a higher magnitude during shorter time intervals, suggesting that hypoglycemic events may trigger AIS [acute ischemic stroke],” the authors wrote. “More granular research should be conducted to assess the link between mild, moderate, and severe cases of hypoglycemia and stroke occurrence, as well as the severity of the stroke. These results, if confirmed in other studies, suggest that avoiding hypoglycemic events may be an important approach to preventing AIS in patients with diabetes.”