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National trends in the achievement of recommended strategies for stroke prevention in US adults with type 2 diabetes, 2001-2018

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posted on 14.07.2022, 15:07 authored by Shihchen Kuo, Chun-Ting Yang, William H. Herman, Lynda D. Lisabeth, Wen Ye

  

Objective: To assess the national prevalence of and trends in achieving current guideline-recommended treatment goals and pharmacotherapies for primary and secondary prevention of stroke among US adults with type 2 diabetes (T2D).

Research Design and Methods: We performed serial cross-sectional analyses in 4,834 adults aged ≥45 years with T2D who participated in the 2001-2018 National Health and Nutrition and Examination Surveys. Stratified by stroke history, we estimated the proportion of adults with T2D who achieved current guideline-recommended strategies for stroke prevention. Preventive strategies for stroke were benchmarked against diabetes care and cardiovascular risk reduction guidelines.

Results: Overall in 2001-2018, among those without stroke history, the proportion who achieved primary stroke prevention strategies ranged from 8.4% (95% confidence interval, 6.8%-10.1%) for aspirin/clopidogrel treatment in those with a higher cardiovascular disease risk to 80.5% (78.8%-82.2%) for non-smoking. Among those with stroke history, the proportion who achieved secondary stroke prevention strategies ranged from 11.8% (8.7%-14.8%) for weight control to 80.0% (74.9%-84.9%) for glycemic control. From 2001 to 2018, among those without stroke history, there was a significant increase in statin therapy (P-trend<0.0001), smoking abstinence (P-trend=0.01) and angiotensin converting enzyme inhibitor/angiotensin receptor blocker treatment for hypertension (P-trend=0.04), but a substantial decline in weight control (P-trend<0.001). Among those with stroke history, only statin therapy (P-trend=0.01) increased significantly over time. 

Conclusions: During 2001-2018, the achievement of some current guideline-recommended strategies for stroke prevention among US adults with T2D improved but remains a challenge overall. Efforts are needed to improve implementation of strategies for stroke prevention in this population.


Funding

The project described was supported by the Diabetes Interdisciplinary Studies (DISP) program by Grant Number P30DK092926 (MCDTR) from the National Institute of Diabetes and Digestive and Kidney Diseases. Role of the Funder/Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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