Low well-being is an independent predictor for stroke in elderly patients with diabetes mellitus

OBJECTIVES: To examine whether psychological factors are risk factors for the development of stroke in elderly diabetic patients. DESIGN: Prospective cohort study. SETTING: Outpatient clinic. PARTICIPANTS: Three hundred seventy-six diabetic outpatients free of stroke; mean age 75. METHODS: Well-being and diabetes-specific burden were assessed at baseline using the Philadelphia Geriatric Center morale scale and the Elderly Diabetes Burden Scale (EDBS), respectively. Symptomatic stroke was defined as a focal neurological deficit with rapid onset that persists for more than 24 hours, supported by brain computed tomography or magnetic resonance imaging. RESULTS: During the 3-year follow-up period, 25 symptomatic strokes (24 ischemic strokes and 1 cerebral hemorrhage) occurred. Low scores on the morale scale (less than or equal to7) were significant predictors for stroke after adjustment for age; sex; body mass index; hemoglobin A(1c) level; systolic blood pressure; serum levels of total cholesterol, triglycerides, and high-density lipoprotein cholesterol; smoking; and previous ischemic heart disease (IHD) (hazard ratio (HR)=3.0, 95% confidence interval (CI)=1.2-7.3, P=.017). The relationship between low morale scores and future stroke remained significant after adjusting for socioeconomic factors and microalbuminuria. Increased symptom burden and social burden, but not dietary restrictions, worry about diabetes mellitus (DM), treatment satisfaction, and burden by tablets or insulin of EDBS, were also significant predictors for stroke after adjustment for age, sex, duration of DM, previous IHD, and microalbuminuria (HR=2.6, 95% CI=1.1-6.5, P=.039). CONCLUSION: Low well-being and symptom burden were predictors of stroke in elderly patients with diabetes mellitus (DM), although the causal relationship remains unknown.