High Risk Diabetics Risk Of Recurrent Stroke And Cardiovascular Disease Persists Even With Patient Personalized Subspecialty Care

Introduction: Diabetes management is an important aspect of stroke prevention. To our knowledge, studies that focus specifically on the role of multidisciplinary teams for adjusting diabetes medications and diabetes education for stroke and cardiovascular disease prevention to compliment standard stroke prevention and nursing education are lacking. Here we sought to evaluate whether high risk diabetics, hemoglobin A1c (HA1c) > 8%, admitted secondary to stroke would benefit from a multidisciplinary team model that also incorporates endocrinology consultation and diabetes education to personalized nursing education and education and management of the admitting service. Methods: Data was obtained from our Institutional Review Board approved stroke admission database from 2017 to November 2019. Regression analysis was used to identify significant associations between diabetes education (DE) and endocrine consultation (EC) with readmission rates with 30 days, re-admission within 30 days secondary to stroke, cardiovascular event or stroke within a year of the stroke admission, and medication change after controlling for age, sex, NIHSS, HbA1c, low density lipoprotein (LDL), reperfusion therapy for acute stroke. Follow-up HbA1c post hospitalization was available for only 17% of the population, and was not included in the regression models. Results: A total of 202 patients were included, median age 66 (interquartile range 56-75), 43% women, NIHSS median 5 (interquartile range (IQR, 2-9), LDL median 105 (IQR, 69-155), A1c median 9.5 (IQR, 8.5 -11.1), and 24% received reperfusion therapy. EC was associated with higher likelihood of a medication change (odds ratio (OR) 9.43, 95% confidence interval (CI) (3.22-30.69). DE was associated with younger age (OR 0.96, 95% CI 0.92-0.99); higher A1c value (OR 1.47, 95% CI 1.18 - 1.87) and higher likelihood of cardiovascular event within a year of the stroke (OR 3.38, 95% CI 1.23 - 9.70). Conclusion: While the endocrine consultation does lead to medications changes with the intent of improving post discharge glycemic control, cardiovascular events were still more likely, possibly from DM disease severity. Further continuation of follow up of these patients with EC and DE after hospital discharge may be needed.