Incidence of stroke, subsequent clinical outcomes and health care resource utilization in people with type 2 diabetes: a real-world database study in France: "INSIST" study

• Published in: Cardiovascular diabetology 2024-05, Vol.23 (1), p.183-13, Article 183
• Main Authors: Mohammedi, Kamel, Fauchier, Laurent, Quignot, Nadia, Khachatryan, Artak, Banon, Tamar, Kapnang, Raissa, Kikuchi, Kazue, Ren, Hongye, Massien, Christine, Vigié, Lucile, Larsen, Sara, Sibon, Igor
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Antihypertensives; Atherosclerotic cardiovascular disease; Cardiac arrhythmia; Cardiovascular Agents - economics; Cardiovascular Agents - therapeutic use; Cardiovascular disease; Cardiovascular diseases; Cerebrovascular disease; Clinical outcomes; Clinical practice guidelines; Codes; Comorbidity; Databases, Factual; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - mortality; Diabetes Mellitus, Type 2 - therapy; Female; France - epidemiology; Glucagon; Glucagon-like peptide 1; Glucose; Health care; Health Care Costs; Health risks; Heart failure; Hemorrhage; Hemorrhagic Stroke - diagnosis; Hemorrhagic Stroke - economics; Hemorrhagic Stroke - epidemiology; Hemorrhagic Stroke - mortality; Hemorrhagic Stroke - therapy; Hospitalization - economics; Hospitals; Humans; Hypoglycemic Agents - economics; Hypoglycemic Agents - therapeutic use; Incidence; Insulin; Ischemia; Ischemic Stroke - diagnosis; Ischemic Stroke - economics; Ischemic Stroke - epidemiology; Ischemic Stroke - mortality; Ischemic Stroke - therapy; Male; Middle Aged; Mortality; Patients; Population; Real-world study; Recurrence; Resource utilization; Retrospective Studies; Risk Assessment; Risk Factors; Statins; Statistical analysis; Stroke; Stroke - diagnosis; Stroke - economics; Stroke - epidemiology; Stroke - mortality; Stroke - therapy; Time Factors; Treatment Outcome; Type 2 diabetes
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-024-02257-4

People with type 2 diabetes (T2D) are at elevated risk of cardiovascular disease (CVD) including stroke, yet existing real-world evidence (RWE) on the clinical and economic burden of stroke in this population is limited. The aim of this cohort study was to evaluate the clinical and economic burden of stroke among people with T2D in France. We conducted a retrospective RWE study using data from the nationally representative subset of the French Système National des Données de Santé (SNDS) database. We assessed the incidence of stroke requiring hospitalization between 2012 and 2018 among T2D patients. Subsequent clinical outcomes including CVD, stroke recurrence, and mortality were estimated overall and according to stroke subtype (ischemic versus hemorrhagic). We also examined the treatment patterns for glucose-lowering agents and CVD agents, health care resource utilization and medical costs. Among 45,331 people with T2D without baseline history of stroke, 2090 (4.6%) had an incident stroke requiring hospitalization. The incidence of ischemic stroke per 1000 person-years was 4.9-times higher than hemorrhagic stroke (6.80 [95% confidence interval (CI) 6.47-7.15] versus 1.38 [1.24-1.54]). During a median follow-up of 2.4 years (interquartile range 0.6; 4.4) from date of index stroke, the rate of CVD, stroke recurrence and mortality per 1000 person-years was higher among hemorrhagic stroke patients than ischemic stroke patients (CVD 130.9 [107.7-159.0] versus 126.4 [117.2-136.4]; stroke recurrence: 86.7 [66.4-113.4] versus 66.5 [59.2-74.6]; mortality 291.5 [259.1-327.9] versus 144.1 [134.3-154.6]). These differences were not statistically significant, except for mortality (adjusted hazard ratio 1.95 [95% CI 1.66-2.92]). The proportion of patients prescribed glucagon-like peptide-1 receptor agonists increased from 4.2% at baseline to 6.6% during follow-up. The proportion of patients prescribed antihypertensives and statins only increased slightly following incident stroke (antihypertensives: 70.9% pre-stroke versus 76.7% post-stroke; statins: 24.1% pre-stroke versus 30.0% post-stroke). Overall, 68.8% of patients had a subsequent hospitalization. Median total medical costs were €12,199 (6846; 22,378). The high burden of stroke among people with T2D, along with the low proportion of patients receiving recommended treatments as per clinical guidelines, necessitates a strengthened and multidisciplinary approach to the CVD prevention and management in people with T