Reducing the Risk of Stroke in Type 2 Diabetes: A Critical Review

REVIEW ARTICLE


Dirk Sander^1,2, Thorleif Etgen^3,4, Holger Poppert² and Kerstin Sander^1,2

Affiliations: ¹Department of Neurology, Medical Park Hospital and ²Department of Neurology, Technische Universität München and ³Department of Neurology,Klinikum Traunstein, Germany and ⁴Department of Psychiatry and Psychotherapy, Technische Universität München, Germany

ABSTRACT

Stroke is the second most frequent cause of death worldwide and the most frequent cause of permanent disability. Patients with diabetes mellitus (Dm) are at 1.5–3 times the risk of stroke compared with the general population. Cerebrovascular disease causes 20% of deaths in diabetic patients. Interestingly, there are some striking differences of stroke patterns between diabetic and nondiabetic subjects suffering a stroke. An ideal treatment of Dm is of enormous concern because of its significance as a risk factor for emerging atherosclerotic diseases such as stroke, as well as in acute stroke, owing to its relevance for the clinical outcome. Intensified blood glucose-lowering regimens using intravenous insulin are currently being replaced by a more liberal therapy on the Stroke unit. Overall, there is a need for rigorous evaluations of new therapeutic approaches in both primary and secondary prevention of stroke and management of acute stroke in patients with type 2 diabetes. Recent data demonstrate that there is no optimum of a target HbA1c that fits for all patients. Instead we will need an individualized therapy taking into account age, comorbidity, duration of diabetes, and side effects of drugs. This review summarizes the evidence regarding current therapeutic interventions and their impact on the risk of stroke in subjects with type 2 diabetes, and highlights potential strategies for improving outcomes.

Keywords: stroke, diabetes mellitus, epidemiology, risk factors, treatment, sex differences

Correspondence: Prof Dr Dirk Sander, Department of Neurology, Medical Park Hospital, Thanngasse 15 83483 Bischofswiesen, Germany. Tel:+49-8652-89517; Fax: +49-8652-89271; e-mail: D.Sander@mac.com