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