Outcome and Quality of Life after Diabetic Stroke

描述(由申请人提供)：就个人而言，糖尿病和中风是导致残疾的最常见原因，并导致大量的医疗保健利用和费用。糖尿病患者中风的年龄较小，死亡或残疾的可能性比非糖尿病患者高得不成比例。这些糟糕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后，糖尿病和血糖升高也一直预示着卒中后不良的功能结局。尽管多项研究令人信服地证明糖尿病患者中风后的预后更差，但这种差异的原因仍不清楚。以前的中风预后研究没有考虑中风后的内科并发症(肺炎、尿路感染等)。或者将抑郁等心理并发症考虑在内。人们普遍认为，这种并发症损害了中风后的康复和感知的生活质量，但只有一项研究以统计学的严谨性证明了这一点。此外，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尚不清楚。在获得这些信息之前，我们将无法为糖尿病患者的卒中预防、急性卒中治疗和卒中后护理制定最佳策略。糖尿病本身对感知的生活质量有重大影响，通常与抑郁症有关，通常有多种医学并存。尽管SF-36等与健康相关的生活质量(HRQOL)测量已经为糖尿病患者标准化，但目前还没有数据显示糖尿病患者中风后HRQOL如何变化。为了确定是否可以改善糖尿病卒中患者的HRQOL，必须收集有关卒中后生活质量的基线数据。我们假设糖尿病患者会有过量的卒中后并发症，这解释了卒中后结局和HRQOL之间的差异。在这项研究完成时，我们将确定每个并发症的发生率及其对预后和HRQOL的影响。通过解释卒中后预后的差异，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。鉴于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学和糖尿病护理之间差距的专家。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.