Outcome and Quality of Life after Diabetic Stroke

描述（由申请人提供）：就个人而言，糖尿病和中风是最常见的致残原因，并导致大量的医疗保健使用和费用。糖尿病患者中风的年龄更小，比非糖尿病患者更容易死亡或致残。这些不良的功能结果给社会带来了高昂的成本。以前的研究，包括我们自己的研究，已经证明，即使在控制了其他重要变量之后，糖尿病和血清葡萄糖升高也始终预测中风后的功能不良结局。虽然多项研究令人信服地证明，糖尿病患者中风后的预后更差，但造成这种差异的原因尚不清楚。以往的卒中结局研究没有考虑卒中后的医学并发症（肺炎、尿路感染等）或心理并发症（如抑郁）。人们普遍认为，这些并发症会损害中风后的康复和生活质量，但只有一项研究用严格的统计数据证明了这一点。此外，尚不清楚这些并发症的发生率在糖尿病患者和非糖尿病患者之间是否存在差异。在获得这些信息之前，我们将无法制定糖尿病患者中风预防、急性中风治疗和中风后护理的最佳策略。糖尿病本身对感知生活质量有重大影响，通常与抑郁症有关，并且通常有多种医学合并症。虽然与健康相关的生活质量（HRQOL）测量，如SF-36，已经标准化了糖尿病患者，但目前还没有数据显示糖尿病患者中风后HRQOL的变化。为了确定糖尿病脑卒中患者的HRQOL是否可以改善，必须收集脑卒中后生活质量的基线数据。我们假设糖尿病患者卒中后并发症过多，这解释了卒中后结局和HRQOL的差异。在本研究结束时，我们将确定每种并发症的发生率及其对结果和HRQOL的影响。通过解释卒中后结果的差异，我们将确定未来干预可以改善糖尿病卒中患者生活质量的领域。考虑到中风给糖尿病患者带来的巨大负担，显然需要一位能够弥合神经病学和糖尿病护理之间鸿沟的专家。首席研究员的目标是成为流行病学和结果研究方面的专家，并利用临床研究来改善糖尿病中风患者的生活。

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.