Objective: To explore the incidence of ischemic stroke after the onset of type 2 diabetes, and further analyze the risk factors, so as to provide a basis for further research.
Methods: The data were obtained from the database of the Beijing Urban Employee Basic Medical Insurance Database. The study used a prospective design to describe the incidence of ischemic stroke in patients with type 2 diabetes. In our study, these patients were followed up for seven years. Multivariate Logistic regression models were used to analyze the risk factors of ischemic stroke in patients with type 2 diabetes.
Results: A total of 185 813 newly diagnosed type 2 diabetes patients were enrolled, with an average age of (58.5±13.2) years, and 49.0% of them were males. A total of 10 393 patients with newly diagnosed ischemic stroke occurred in 7 years, with a cumulative incidence of 5.6% and an incidence density of 8.1/1 000 person-years. Ischemic stroke occurred in all age groups in patients with type 2 diabetes. The cumulative incidence was 1.5% (95%CI: 1.3%-1.6%) in group ≤44 years old, 3.6% (95%CI: 3.4%-3.7%) in group 45-54 years old, 5.4% (95%CI: 5.2%-5.5%) in group 55-64 years old, and 9.2% (95%CI: 9.0%-9.4%) in group ≥65 years old, and the cumulative incidence increased with age (P < 0.05). Cumulative incidence rate of the males (6.8%, 95%CI: 6.7%-7.0%) was higher than the females (4.4%, 95%CI: 4.3%-4.6%). Among the patients < 80 years old, the cumulative incidence rate of the males was higher than that of the females in all the age groups. In the patients ≥80 years of age, the cumulative incidence was higher in the females (9.2%) than in the males (7.9%). Further analysis revealed that complications, such as coronary heart disease (OR=3.18, 95%CI: 2.72-3.72), heart failure (OR=1.53, 95%CI: 1.32-1.79) and kidney failure (OR=1.45, 95%CI: 1.20-1.75) were associated with ischemic stroke in the patients with type 2 diabetes.
Conclusion: The incidence level of ischemic stroke in patients with type 2 diabetes is high. It is necessary to strengthen the management of risk factors in elderly patients, screen the complications of type 2 diabetes as early as possible, and take active preventive and control measures.
目的: 通过对新发2型糖尿病患者进行前瞻性观察，探究2型糖尿病发病后缺血性脑卒中的发病特点，并进一步分析2型糖尿病患者缺血性脑卒中发病的危险因素。
方法: 数据资料来源于北京市城镇职工基本医疗保险信息系统数据库。研究采用前瞻性设计，对2010年新诊断为2型糖尿病的患者在2010—2017年缺血性脑卒中的发病情况进行描述，采用Logistic回归模型分析2型糖尿病患者缺血性脑卒中发病的危险因素。
结果: 共纳入185 813例新发2型糖尿病患者，平均年龄(58.5±13.2)岁，男性占49.0%。随访7年内出现新发缺血性脑卒中患者10 393例，累积发病率为5.6%，发病密度为8.1/1 000人年。2型糖尿病患者缺血性脑卒中在各个年龄段均有发生，不同年龄组累积发病率分别为：≤44岁组1.5%(95%CI：1.3%~1.6%)，45~54岁组3.6%(95%CI：3.4%~3.7%)，55~64岁组5.4%(95%CI：5.2%~5.5%)，≥65岁组9.2%(95%CI：9.0%~9.4%)，累积发病率随年龄升高而增加(P < 0.05)。男性累积发病率(6.8%，95%CI：6.7%~7.0%)高于女性(4.4%，95%CI：4.3%~4.6%)； < 80岁的患者中，男性在各年龄段累积发病率均高于女性；≥80岁的患者中，女性累积发病率(9.2%)高于男性(7.9%)。进一步分析2型糖尿病患者缺血性脑卒中发病的危险因素，发现患有冠心病(OR=3.18，95%CI：2.72~3.72)、心力衰竭(OR=1.53，95%CI：1.32~1.79)、肾衰竭(OR=1.45，95%CI：1.20~1.75)等合并症与2型糖尿病患者缺血性脑卒中的发病有关。
结论: 2型糖尿病患者缺血性脑卒中发病率仍处于较高水平，应针对老年患者加强危险因素管理，尽早筛查2型糖尿病患者的合并症情况并采取针对性的预防控制措施。
Keywords: Diabetes complication; Diabetes mellitus, type 2; Incidence; Stroke.