Midlife Diabetes Increases Cerebral Infarction, Arterial Occlusion Risk in Late Life

Brain stroke : 3d illustration of the vessels of the brain and causes of stroke
Patients with midlife type 2 diabetes have a significantly increased risk for cerebral infarction and occlusion of cerebral arteries later in life.

Patients with midlife type 2 diabetes have a significantly increased risk for cerebral infarction and occlusion of cerebral arteries later in life, according to study results published in Diabetologia.

The results did not, however, indicate that these patients have an increased risk for intracerebral hemorrhage or subarachnoid hemorrhage.

The study included participants who were twins born in 1958 or earlier in whom no cerebrovascular disease was documented before the age of 60 (n = 33,086). The researchers used self-reported data, the National Patient Registry, and record of glucose-lowering medication use to determine the rate of midlife type 2 diabetes (onset at age 40-59 years). They used National Patient Registry records to identify cerebrovascular disease diagnosis (cerebral infarction, occlusion of cerebral arteries, subarachnoid hemorrhage, intracerebral hemorrhage, and unspecified cerebrovascular disease) and age of onset.

The researchers defined late-life cerebrovascular disease as age of onset ≥60 years. They used generalized estimating equation models to analyze unmatched case-control data after adjusting for the clustering of twins within a pair. They also used conditional logistic regression in co-twin matched case-control analyses in twin pairs in which one twin had cerebrovascular disease.

Of the participants, 3.8% (n = 1248) had midlife type 2 diabetes and 9.4% (n = 3121) had cerebrovascular disease in late life.

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After adjusting for age, sex, education, body mass index, smoking, alcohol consumption, marital status, hypertension, and heart disease, the researchers found that participants with type 2 diabetes had an odds ratio of 1.29 for cerebral infarction (95% CI, 1.03-1.61), 2.03 for occlusion of cerebral arteries (95% CI, 1.20-3.44), 0.52 for subarachnoid hemorrhage (95% CI, 0.12-2.21), and 0.78 for intracerebral hemorrhage (95% CI, 0.45-1.36).

Results from the co-twin analysis did not differ significantly from the general estimating model, indicating that genetic and familial environmental factors in early life likely did not contribute as confounders.

“Our findings highlight the need to control midlife type 2 diabetes to help prevent cerebral infarction and occlusion of cerebral arteries in late life,” the researchers wrote.

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Yang R, Pedersen NL, Bao C, et al. Type 2 diabetes in midlife and risk of cerebrovascular disease in late life: a prospective nested case-control study in a nationwide Swedish twin cohort [published online June 5, 2019]. Diabetologia. doi:10.1007/s00125-019-4892-3