1 Department of Clinical Epidemiology, Faculty of Health Sciences, Aarhus University, Aarhus University2 Department of Pharmacology, Faculty of Health Sciences, Aarhus University, Aarhus University3 The Department of Endocrinology and Metabolism C, Faculty of Health Sciences, Aarhus University, Aarhus University4 Department of Economics and Business Economics, Aarhus BSS, Aarhus University5 Department of Clinical Medicine - Department of Clinical Epidemiology, Department of Clinical Medicine, Health, Aarhus University6 Department of Biomedicine - Forskning og uddannelse, Øst, Department of Biomedicine, Health, Aarhus University7 Department of Economics and Business Economics, Aarhus BSS, Aarhus University8 Department of Clinical Medicine - Department of Clinical Epidemiology, Department of Clinical Medicine, Health, Aarhus University9 Department of Biomedicine - Forskning og uddannelse, Øst, Department of Biomedicine, Health, Aarhus University
a nationwide follow-up study
BACKGROUND: We examined whether the preadmission use of sulfonylureas is associated with improved clinical outcome compared with other antidiabetic treatments after hospitalization with ischemic stroke. METHODS: We conducted a nationwide population-based follow-up study among all Danish patients hospitalized with ischemic stroke between 2003 and 2006 and who were registered in the Danish National Indicator Project. We obtained data on diabetes and type of antidiabetic treatment, patient characteristics, in-hospital quality of care, and mortality and readmissions by linking medical databases. We computed mortality rates and rates of readmission recurrent ischemic stroke or myocardial infarction according to type of treatment and used the Cox proportional hazards regression analysis to compute hazard ratios (HRs). RESULTS: We identified 4817 stroke patients with type 2 diabetes mellitus. We found lower 30-day mortality rates among users of metformin (adjusted HR 0.32; 95% confidence interval [CI] 0.15-0.68), insulin (adjusted HR 0.47; 95% CI 0.27-0.81), and patients without antidiabetic pharmacotherapy (adjusted HR 0.58; 95% CI 0.36-0.93) compared with users of sulfonylureas. Users of any combination had a nonstatistical significant lower 30-day mortality rate (adjusted HR 0.64; 95% CI 0.34-1.21). In contrast, we found no significant differences in 1-year mortality rate. Compared with users of sulfonylureas, users of all other types of treatment had increased risk of readmission; however, it did not reach statistical significance for all treatment groups. CONCLUSIONS: Preadmission use of sulfonylureas appeared not to be associated with an overall improved clinical outcome among type 2 diabetic patients admitted with ischemic stroke.
Journal of Stroke and Cerebrovascular Diseases, 2012, Vol 21, Issue 8, p. 717-25
Aged; Aged, 80 and over; Brain Ischemia; Denmark; Diabetes Mellitus, Type 2; Female; Follow-Up Studies; Health Care Surveys; Hospitalization; Humans; Hypoglycemic Agents; Insulin; Male; Metformin; Middle Aged; Myocardial Infarction; Patient Readmission; Proportional Hazards Models; Recurrence; Registries; Risk Factors; Stroke; Sulfonylurea Compounds; Time Factors; Treatment Outcome