Outcome and Quality of Life after Diabetic Stroke

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DESCRIPTION (provided by applicant): Individually, diabetes and stroke are among the most common causes of disability and result in substantial health care utilization and expense. Diabetic patients suffer stroke at a younger age and are disproportionately more likely to die or become disabled than non-diabetic patients. These poor functional outcomes have high costs for society. Previous studies, including our own, have demonstrated that diabetes and elevated serum glucose consistently predict poor functional outcome following stroke even after controlling for other significant variables. While multiple studies convincingly document that post-stroke outcomes are worse in patients with diabetes, the reasons for this disparity remain unclear. Previous stroke outcome studies have not taken post-stroke medical complications (pneumonia, urinary tract infections, etc.) or psychological complications such as depression into account. It is generally accepted that such complications impair recovery and perceived quality of life after stroke, and yet only one study has proven this with statistical rigor. Furthermore, it is not known if the rates of these complications differ between diabetic and non-diabetic patients. Until this information is available, we will be unable to develop optimal strategies for stroke prevention, acute stroke treatment, and post-stroke care in diabetic patients. Diabetes itself has a significant impact upon perceived quality of life, is commonly associated with depression, and usually has multiple medical co-morbidities. Although health-related quality of life (HRQOL) measures such as the SF-36 have been standardized for patients with diabetes, there are currently no data showing how HRQOL changes after stroke in patients with diabetes. To determine if HRQOL can be improved for diabetic stroke patients, baseline data regarding post-stroke quality of life must be collected. We hypothesize that there will be an excess of post-stroke complications in diabetic patients, explaining the disparity in post-stroke outcomes and HRQOL. At the completion of this study, we will have determined the incidence of each complication and its impact on outcome and HRQOL. By explaining the disparity in post-stroke outcomes, we will have identified areas where future interventions could improve the quality of life for diabetic stroke patients. Given the enormous burden of stroke on patients with diabetes, the need for a specialist that can bridge the gap between neurology and diabetes care is evident. It is the goal of the Principal Investigator to become an expert in epidemiology and outcomes research and to use clinical research to improve the lives of diabetic patients with stroke.