# Prevalence, Awareness, Treatment, and Control of Diabetes Among 0.98 Million Patients With Stroke/TIA in China: Insights From a Nationwide Cohort Study

## TL;DR

The study finds that over two-thirds of stroke/TIA patients in China have diabetes, which increases in-hospital mortality and highlights the need for early screening and intervention.

## Contribution

The study provides nationwide insights into diabetes prevalence, awareness, treatment, and control among stroke/TIA patients in China.

## Key findings

- Over 37% of stroke/TIA patients had diabetes, with nearly a third undiagnosed.
- Undiagnosed and untreated diabetes were strongly associated with higher in-hospital mortality.
- Controlled diabetes was linked to lower in-hospital death risk compared to uncontrolled diabetes.

## Abstract

A comprehensive epidemiological investigation of the coexistence between diabetes and stroke/TIA in China is urged.

Data from the Chinese Stroke Center Alliance program, a nationwide multi‐center registry study, were used to detect the prevalence, awareness, treatment, and control of diabetes among stroke/TIA. The distribution of diagnosed and undiagnosed diabetes and prediabetes among stroke/TIA patients was investigated, the medical care around diabetes and their respective risk predictors were analyzed, and the association of all above diabetes characteristics with in‐hospital death was evaluated using multi‐variable Cox regression models.

Of 980 625 patients included, 308 426 (31.5%) had prediabetes, while 365 052 (37.2%) had diabetes, with nearly a third of them undiagnosed (112 969, 30.9%). Of residual aware diabetic patients, 59.0% were treated, with 27.3% controlled. Compared to Han ethnicity, Zhuang ethnicity had a lower prevalence of diabetes (37.3% vs. 35.1%) but were less aware (69.4% vs. 56.5%), treated (59.4% vs. 47.8%), and controlled (27.4% vs. 26.0%). Patients with prediabetes, diagnosed, and undiagnosed diabetes had increasingly higher risks of in‐hospital death (adjusted HR [95% CI]: 1.47 [1.35–1.60]; 2.15 [1.97–2.34]; 4.20 [3.87–4.56], all p < 0.001). Unaware and untreated diabetes were independently associated with in‐hospital death (adjusted HR [95% CI]: 1.99 [1.85–2.14]; 2.84 [2.63–3.07, both p < 0.001]). Compared with controlled diabetes, those with uncontrolled diabetes had a lower risk of in‐hospital death (adjusted HR [95% CI]: 0.77[0.68–0.88], p < 0.001).

The findings indicate that over two‐thirds of stroke/TIA patients are exposed to diabetes in China, causing higher in‐hospital mortality, which should be screened and intervened early.