Pashkovska N.V.

Bukovinian State Medical University, Chernivtsy, Ukraine

RISK FACTORS OF THE DEVELOPMENT OF CHRONIC IMPAIRMENT OF CEREBRAL CIRCULATION IN PATIENTS WITH DIABETES MELLITUS IN DEPENDENCE ON ITS TYPE

Cerebral stroke is considered to be one of the most frequent and most severe vascular impairments due to a great mortality rate and limited chance to restore previous disability. Being the third largest cause of death and major cause of adult disability, it affects more than 700,000 individuals each year [4].

One of the leading causes of cerebrovascular pathology is diabetes mellitus (DM), as far as chronic hyperglycemia stipulates metabolic and vascular changes in the brain [4, 6].

Incidence of stroke was from two- to fivefold higher in individuals suffering from DM as compared with those without diabetes [2, 3]. Contributors for increased risk of stroke in the diabetic population included elevated blood pressure, smoking, age, male sex, atrial fibrillation, and hyperglycemia [3-5]

Aiming to reveal the risk factors for acute impairment of cerebral circulation (AICC) in diabetic patients and to evaluate the magnitude of their influence, 333 cases of diabetes-associated AICC were analyzed in dependence on the type of DM.  Gender and age, history of frequent exposure to stress and hypertension, influence of season and daytime, features of diabetes clinical course (its type,  duration, severity, compensation, hypoglycemic therapy, etc.) were analyzed as possible contributors to the causality of cerebral stroke in diabetics. The risk factors for cerebral stroke with the fatal outcome in patients with DM were assessed independently.

According to the results of present study, AICC was more common for type 2 diabetics (287 cases as compared with 46 type 1 DM cases), mostly women (71,7 and 61,7% in type 1 and 2 diabetes accordingly).

The age of 50 – 69 (for insulin-dependent DM) and 60 and over (for non-insulin-dependent DM) appeared to be the highly critical for diabetic patients (tabl.1).

Òàble 1

Distribution of patients according to age and sex in dependence on the type of DM

Characteristic

Type of DM

type 1

type 2

Total number of study participants

46

287

Sex:

 

 

§        male

13

28,3%

100

34,8%

§        female

33

71,7%

187

65,2%

Age:

 

 

§        under 40 years

1

2,2%

-

§        40-49 years

9

19,6%

27

9,4%

§        50-59 years

15

32,6%

75

26,1%

§        60-69 years

13

28,2%

98

34,2%

§        70-79 years

8

17,4

73

25,4%

§        80-89 years

-

14

4,9%

Risk factors:

 

 

smoking

2

4,3%

12

4,1%

stresses

45

97,8%

249

86,7%

Hypertension:

 

 

§        normal blood pressure

-

5

1,7%

§        grade ² hypertension

2

4,3%

7

2,4%

§        grade I² hypertension

6

13,0%

66

22,9%

§        grade II² hypertension

38

82,6%

201

70,0%

²schemic heart disease

36

78,3%

244

85,0%

 

The incidence of ischemic cerebral stroke was high in both types of DM. The percentage of hemorrhagic cerebral stroke, as well as mortality rate, prevailed in type 1 diabetes (tabl.2).

Òable 2

Characteristics of AICC episodes in dependence on the type of DM

Characteristic

Type of DM

type 1

type 2

Type of AICC:

 

 

§        transient ischemic attack

3

6,5%

22

7,7%

§        acute hypertensive encephalopathy

-

3

1,0%

§        ischemic stroke

41

89,1%

259

90,3%

§        hemorrhagic stroke

2

4,4%

3

1,0%

Time of occurrence of AICC episode:

 

 

§        first

30

65,2%

182

63,4%

§        recurrent

16

34,8%

105

36,6%

Season of occurrence of AICC episode:

 

 

§        winter

12

26,1%

54

18,8%

§        spring

10

21,7%

84

29,3%

§        summer

8

17,4%

63

22,0%

§        autumn

16

34,8%

86

29,9%

Day period of occurrence of AICC episode:

 

 

§        morning

17

37,0%

84

29,3%

§        day-time

10

21,7%

65

22,6%

§        evening

7

15,2%

58

20,2%

§        night

12

26,1%

80

27,9%

Number of fatal outcomes

9

19,6%

21

7,3%

Autumn-winter and autumn-spring period was found to be more dangerous concerning the development of AICC for type 1 and type 2 diabetics accordingly, commonly at morning and night time.

The risk of AICC was greatly increased in patients with type 1 DM of severe course and type 2 DM of mild and moderate course, if subcompensated, with duration of insulin-dependent and non-insulin-dependent DM over 10 and 5 years respectively.

Cerebrovascular disorders are known to be the major cause of developing long-term complications and death of patients, mostly in case of type 2 DM (validated by raised mortality), whereas the likelihood of death from cerebrovascular pathology has not been previously reported for type 1 diabetics.

References

1.                 Almdal T., Scharling H., Jensen J.S. et al. The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up // Arch Intern Med. – 2004. - Vol.164. – P. 1422–1426.

2.                 Gaede P., Vedel P., Larsen N. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes // N Engl J Med. – 2003. - Vol.348. – P. 383–393.

3.                 Ho J.E., Paultre F., Mosca L: Is diabetes mellitus a cardiovascular disease risk equivalent for fatal stroke in women? Data from the Women's Pooling Project. //Stroke. -  2003. – Vol. 34. – P.2812–2816.

4.                 Kissela B.M., Khoury J., Kleindorfer D. et al. Epidemiology of ischemic stroke in patients with diabetes: the Greater Cincinnati/Northern Kentucky Stroke Study // Diabetes Care. – 2005. - Vol.28. – P. 355–359.

5.                 Mooradian A.D: Cardiovascular disease in type 2 diabetes mellitus: current management guidelines // Arch Intern Med. – 2003. - Vol. 163. – P.33–40.

6.                 Ottenbacher K.J., Ostir G.V., Peek M.K.Diabetes mellitus as a risk factor for stroke incidence and mortality in Mexican American older adults //J Gerontol A Biol Sci Med Sci. – 2004. – Vol. 59. – P.640–645.