Features of the course and treatment of acute stroke in patients with diabetes mellitus

Abstract

Diabetes mellitus (DM) is one of the causes and an important risk factor for acute stroke (AS), and a stroke, in turn, is one of the causes of the development of decompensation of DM.

The objective: to analyze the peculiarities of the course and treatment of AS in patients with DM and other carbohydrate metabolism disorders.

Materials and methods. A retrospective analysis of the disease histories was carried out on 416 patients with AS. Patients were studied in three groups: 1) diabetic patients with AS, 2) patients with the first detected diabetes and 3) patients without diabetes.

Results. In patients with diabetes, ischemic stroke was significantly prevalent (107 out of 110 patients, or 97.3%). Cases of hemorrhagic AS in these patients were isolated and practically casuistic. Patients hospitalized in the intensive care unit (ICU) had a course ranging from moderate to extremely severe (scores for NIHSS ranged from 9 to 18, with a maximum of 34 points). Neuroprotectors were intended for almost all (99.6%) patients with acute stroke, starting from 1–2 days. In some cases, 2–3 neuroprotectors were prescribed at a time. The main reason for the repeated transfer of patients to the ICU by 2–3 and 8–9 days was a violation of external breathing.

Conclusions. As a result of the analysis of treatment of diabetic patients with AS, it was determined that the following directions of intensive care of these patients should be improved: 1) detection and diagnosis of diabetes and occult forms of carbohydrate metabolism disorders; 2) diagnostics, monitoring and correction of respiratory disorders; 3) infusion therapy (fluid balance, choice of solutions)