Cerebro-Vascular Pathology of Elderly diabetics

72 case-studies

S. Hannat - R. Chermat - R. Malek

Internal Medical Service

University Hospital Centre Setif

Algeria

Malta, April 23–26, 2009

Introduction

Stroke affects more than 700,000 individuals each year.

it is the third largest cause of death and the largest cause of adult disability in the U.S A (1).

Diabetes is clearly one of the most important risk factors for ischemic stroke(2).

Diabetes is associated with an increased incidence of stroke and death among elderly people (3)

(1)Stroke. 2008;39:1142-1147.

(2) Diabetes Care 30:3131-3140, 2007

(3) Journal of Gerontology 2004, Vol. 59A, No. 6, 640–645

Objectives

Estimate the incidence of stroke among hospitalized diabetics.

Analyze the type and the progression of the stroke

Characteristics of the elderly patient

Patients and Methodology Retrospective studyTarget population: elderly diabetics Duration: 3 years Parameters studied: - age, gender, onset of diabetes, lipid check up, HbA1c

- Check up of complications

- Associeted causes of morbidity

Number of stroke among elderly diabetics / Total number of hospitalized diabetics

0

200

400

600

800

1000

total number ofhospitalizeddiabetics number of strokeamong elderlydiabetes

803

72

9% ±1,96 (95% CI 7,04 to 10,96)

Number of stroke among elderly diabetics / Total number of stroke

0

40

80

120

160157

72

46% ± 7,78 (95% CI 54 to 38)

Total number of stroke

Number of stroke among elderly diabetics

Distribution by gender Blood glucose control on admission

Ratio 1M / 2W

Total number of stroke 72

Averrage lenght of the evolution of diabetes : 10 years ± 3,76 years

Men

Woman

24

48

HbA1c %

< 7% 9 %

>7% et < 10 % 46%

> 10% 45 %

Distribution by age range

0

5

10

15

20

25

30

35

(65-74)y (75-84)y over 85y

« Young-old » 65 - 74 years

« Middle-old» 75 - 84 years

« Old-old» over 85 years

Elderly adult : WHO > 65 years

Woman

Men

(y)

Type of stroke Short Term Progress

87%

13%

ischemic

haemorrhagic

0

10

20

30

40

50

60 73,6%

19,4%6,94%

Associated cardio-vasculars risk factors

85%

0

15

30

45

60

75

34,4%

7% 10% 3%

Comments Stroke is common in elderly diabetics.

9 % hospitalized diabetics had stroke.

46% of all stroke victims are elderly diabetics

A majority of stroke victims are women (gender ratio 0,5).

The highest frequency of stroke victims is in the 65-74 years age range.

Comments The onset of type II diabetes as well as chronic imbalance

could be risk factors in the occurance of a complication. Ischemic stroke is the predominant type.

The risk is usually higher among hypertensive elderly diabetics with atrial fibrillation or previous stroke.

Immediate progress : High mortality rate (20% of cases).

Conclusion The risk of ischemic stroke is higher among elderly

diabetics.

L’HTA , atrial fibrilation , chronic métabolit imbalance, previous stroke incidents are determining factors

This complication has a hight probality of resuiting in disability or death.