Diabetes Duration vs Stroke

There's diabetes.  And then there's diabetes.  Over the years, I've had patients come in with Hemoglobin A1c (HgbA1c) results so high, the lab basically just gives up and says >14% or something like that.  It just won't measure it, it's so high.  And then there are those patients who've seen the light and are scared sh-tless and drop their values from double digits down to <7% in 3-6 months.  I'm sure you've had your share of these extremes.  Well, it turns out it not just the quality of control that matters, but the duration of disease, too, at least with regards to stroke risk.

In a population-based cohort study published early last week prior to print in May, the authors noted that the duration of diabetes increases stroke risk by 3% per year and triples risk after 10 years.  Of course, this is in comparison to those patients who were not diabetics and did not become diabetic.  The authors arrived at their conclusion by evaluating 3,298 participants of the Northern Manhattan Study who were free of stroke at baseline and then followed for 9 years.  These participants were average 69yo, more than half of whom were Hispanic, a quarter of whom were black and a quarter of whom were white.  About a quarter had diabetes at baseline while one in ten developed diabetes during the observation period.  Those who had diabetes at baseline had the disease an average of 13+ years.  Those who developed diabetes had it for an average of 4+ years during the study period.

This is all well & good and if you buy into the theory that vascular disease is a total body phenomena not isolated to the heart, then it makes sense that a disease (diabetes) associated with heart disease is also associated with stroke risk.  But unfortunately, it doesn't explain or look into the effect of diabetic control on stroke risk.  After all, wouldn't it be a more impressive carrot to dangle in front of patients if we could tell them that lower HgbA1c is associated with lower stroke risk?  It would certainly be better news than saying once you've got the disease, if you live long enough (<10yrs), you're going to triple your risk for a stroke.  That's a stick if I ever heard one.

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