Impact of insulin resistance on post-stroke depression and outcomes in diabetes.

Aims: This study aimed to examine the association between insulin resistance (IR) and post-stroke depression (PSD) occurrence in diabetic patients, providing novel insights for PSD prevention and treatment strategies.

Materials and methods: Clinical data from 124 patients with acute cerebral infarction and diabetes mellitus were retrospectively analyzed. Based on the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), participants were stratified into two groups: an IR group (HOMA-IR > 2.69, n = 96) and a control group (HOMA-IR ≤ 2.69, n = 28). The occurrence of PSD was compared between the two groups by unadjusted analysis and inverse probability of treatment weighting (IPTW), and the correlation between HOMA-IR scores and PSD was analyzed by multivariate logistic regression.

Results: At 3-month follow-up, the IR group exhibited significantly higher Hamilton Depression Scale (HAMD) scores (median 8 vs 6, P = 0.029) and a 3.28-fold increased PSD risk (OR = 3.28, 95% CI: 1.37-7.88, P = 0.006). After adjusting for baseline confounders using IPTW, the IR group maintained elevated PSD risk (adjusted OR = 2.64, P = 0.035). Multivariate analysis confirmed HOMA-IR as an independent PSD predictor (OR = 1.755, 95% CI: 1.360-2.263, P < 0.001), with ROC analysis demonstrating moderate predictive accuracy (AUC = 0.76, 51.4% sensitivity, 94.2% specificity at cutoff 5.2).

Conclusions: Elevated HOMA-IR levels in diabetic patients with acute cerebral infarction are significantly associated with increased PSD incidence.