Deans' stroke musings: Type 1 or Type 2: Which Patients With Diabetes Face Greater Stroke Risk?

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, May 23, 2025

Type 1 or Type 2: Which Patients With Diabetes Face Greater Stroke Risk?

Will your competent? doctor ENSURE you don't get a stroke with either type? That would be my definition of competence.

Type 1 or Type 2: Which Patients With Diabetes Face Greater Stroke Risk?

Ischemic stroke risk was associated with higher A1C levels among individuals with type 1 and type 2 diabetes.

Compared with the general population, individuals with type 1 diabetes (T1D) had a higher risk for both ischemic stroke and hemorrhagic stroke; however, those with type 2 diabetes (T2D) had a significantly higher risk for ischemic stroke vs hemorrhagic stroke. These are the findings of a study published in Neurology.

Diabetes is associated with increased risk for cardiovascular complications, including ischemic stroke, however, the relationship with hemorrhagic stroke risk remains unclear.

Researchers from the University of Gothenburg sourced data for this study from the National Diabetes Register (NDR) and Total Population Register (TPR), which are nationwide databases from Sweden. Patients with T1D (n=47,720) or T2D (n=686,158) in 2005 to 2019 were each matched with 3 individuals without diabetes (T1D: n=143,160; T2D: n=2,058,474) and evaluated for incident stroke through 2022.

Further research is needed to better understand the mechanisms behind the increased hemorrhagic stroke risk in type 1 diabetes and to refine stroke prevention strategies for both diabetes types.

Table 1 presents the demographic characteristics and anticoagulant and antiplatelet usage of participants with T1D, T2D, and their respective control groups.

Group	% Men	Mean Age (years)	% Using Anticoagulants	% Using Antiplatelets
T1D	55.2%	34.4	2.4%	14.9%
T1D Control Group	55.2%	34.4	5.8%	17.4%
T2D	56.7%	65.3	12.0%	37.7%
T2D Control Group	56.7%	65.3	6.7%	18.3%

During follow-up, 0.6% of patients with T1D and 1.0% of patients with T2D had an incident hemorrhagic stroke compared with 0.3% and 1.0% among their respective control cohorts. Both patients with T1D (4.0% vs 1.5%) and T2D (9.0% vs 6.1%) had higher rates of incident ischemic stroke during follow-up than control individuals, respectively.

In the T1D analyses, T1D was associated with risk for both hemorrhagic (hazard ratio [HR], 1.88; 95% CI, 1.57-2.26; P <.001) and ischemic (HR, 2.54; 95% CI, 2.36-2.73; P <.001) stroke. Conversely, in the T2D analyses, T2D was not associated with hemorrhagic stroke risk (HR, 0.99; 95% CI, 0.96-1.02; P =.621) but was associated with ischemic stroke risk (HR, 1.37; 95% CI, 1.35-1.38; P <.001).

In both T1D and T2D analyses, additional predictors for hemorrhagic and ischemic stroke risk included increased age, male gender, hypertension, a history of stroke, lower income, and lower education. Ischemic stroke was additionally related with antiplatelet use, alcohol use, atrial fibrillation, myocardial infarction, and heart failure.

When glycated hemoglobin (HbA_1c) levels were considered, in T1D hemorrhagic stroke risk was associated with HbA_1c of 52 mmol/mol or greater (HR range, 1.58-2.56; all P ≤.022) and ischemic stroke with HbA_1c of 42 mmol/mol or greater (HR range, 1.65-3.83; all P ≤.001). In T2D, hemorrhagic stroke risk was associated with HbA_1c greater than 72 mmol/mol (HR, 1.21; P <.001) and ischemic stroke with any level of HbA_1c (HR range, 1.13-1.82; all P ≤.001).

This study was limited by only including covariate data collected at baseline and did not account for longitudinal changes in sociodemographic or clinical characteristics.

“Further research is needed to better understand the mechanisms behind the increased hemorrhagic stroke risk in type 1 diabetes and to refine stroke prevention strategies for both diabetes types,” the researchers concluded.

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