Determining the joint effect of obesity and diabetes on functional disability at 3-months and on all-cause mortality at 1-year following an ischemic stroke

• Published in: BMC endocrine disorders Vol. 18; no. 1; pp. 40 - 9
• Main Authors: Bauza, Colleen, Yeatts, Sharon D., Borg, Keith, Magwood, Gayenell, Martin, Renee’ H., Selassie, Anbesaw, Ford, Marvella E.
• Format: Journal Article
• Language: English
• Published: London BioMed Central 18.06.2018; BioMed Central Ltd; BMC
• Subjects: Aged; All-cause mortality; Analysis; Care and treatment; Clinical Trials as Topic; Complications and side effects; Data processing; Diabetes; Diabetes Complications; Diabetes mellitus; Endocrinology; Epidemiology of Endocrine Disorders; Female; Functional disability; Health aspects; Health risk assessment; Humans; Ischemia; Joint effect; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Mortality; Obesity; Obesity - complications; Odds Ratio; Patient outcomes; Research Article; rology; Stroke; Stroke - complications; Stroke - mortality; Stroke Rehabilitation; Studies; Time Factors; Type 2 diabetes; United States; Greenland; Obesity; All-cause mortality; Diabetes; Functional disability; Joint effect
• ISSN: 1472-6823; 1472-6823
• DOI: 10.1186/s12902-018-0255-1

Background Obesity and diabetes mellitus, or diabetes, are independently associated with post-ischemic stroke outcomes (e.g. , functional disability and all-cause mortality). Although obesity and diabetes are also associated with post-ischemic stroke outcomes, the joint effect of obesity and diabetes on these post-ischemic stroke outcomes has not been explored previously. The purpose of the current study was to explore whether the effect of obesity on post-ischemic stroke outcomes differed by diabetes status in a cohort of acute ischemic stroke subjects with at least a moderate stroke severity. Methods Data from the Interventional Management of Stroke (IMS) III clinical trial was analyzed for this post-hoc analysis. A total of 656 subjects were enrolled in IMS III and were followed for one year. The joint effects of obesity and diabetes on functional disability at 3-months and all-cause mortality at 1-year were examined. Results Of 645 subjects with complete obesity and diabetes information, few were obese (25.74%) or had diabetes (22.64%). Obese subjects with diabetes and non-obese subjects without diabetes had similar odds of functional disability at 3-months following an ischemic stroke (adjusted common odds ratio, 1.038, 95% CI: 0.631, 1.706). For all-cause mortality at 1-year following an ischemic stroke, obese subjects with diabetes had a similar hazard compared with non-obese subjects without diabetes (adjusted hazard ratio, 1.005, 95% CI: 0.559, 1.808). There was insufficient evidence to declare a joint effect between obesity and diabetes on either the multiplicative scale or the additive scale for both outcomes. Conclusions In this post-hoc analysis of data from the IMS III clinical trial of acute ischemic stroke patients with at least a moderate stroke severity, there was not sufficient evidence to determine that the effect of obesity differed by diabetes status on post-ischemic stroke outcomes. Additionally, there was not sufficient evidence to determine that either factor was independently associated with all-cause mortality. Future studies could differentiate between metabolically healthy and metabolically unhealthy patients within BMI categories to determine if the effect of obesity on post-stroke outcomes differs by diabetes status.