Ischemic stroke subtypes in subjects with and without diabetes: data from two hospitals in Mongolia

Abstract

According to the World Health Organization report in 2020, the number of stroke deaths in Mongolia has reached 4,401, accounting for 19.84% of the total deaths, ranking as the second leading cause of death in Mongolia. Furthermore, the prevalence of diabetes has been steadily increasing for the last 20 years. In this case-control study (80 diabetic and 160 non-diabetic subjects), we analyzed data from two tertiary stroke centers over the past six months (June-December 2022). Inclusion criteria included patients over 18 years who presented to the emergency department with an acute ischemic stroke (I63 according to ICD 10). We reviewed and compared the data on clinical assessments such as the National Institutes of Health The Stroke Scale (NIHTSS), Glasgow Coma Scale and Modified Rankin Score, laboratory parameters, and TOAST classification of ischemic stroke between diabetic and non-diabetic patients in Mongolia. The mean age was 39.2±15.2, and 33.2% (n = 392) were male. The duration of diabetes in patients ranged from 0 to 23 years, and the median was 5.0. Mean glycated haemoglobin in subjects was 9.75±2.49%, and only 27.5% (n = 22) had HbA1c below 7.5%. Only BMI was significantly different in patients with diabetes compared to patients without diabetes (27.2±4.4 vs. 28.6±5.2). However, for other parameters, no significant difference was observed, but the NIHTSS at discharge was significantly higher in patients with diabetes. According to the TOAST classification, the risk of ischemic stroke caused by microangiopathy (18% vs 33.8%, p=0.142) and macroangiopathy (44.4% vs 57.5%, p=0.192) was 13-15% higher in people with diabetes than in people without diabetes. In regression analysis, patients with diabetes had a six times greater risk of ischemic stroke caused by atherosclerosis than non-diabetic patients. Most subtypes of stroke that occur in people with diabetes are caused by atherosclerosis, both large and small vessels.