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Diabetes as An Independent Risk Factor for Stroke Recurrence in Ischemic Stroke Patients: An Updated Meta-analysis

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)427-435
Issue number6
Early online date21 Oct 2021
Accepted/In press26 Aug 2021
E-pub ahead of print21 Oct 2021
Published1 Dec 2021


King's Authors


Introduction: Stroke and its recurrence, and diabetes, will increase in incidence as the population ages globally. This study explores the relationship between diabetes and stroke recurrence to understand if diabetes is an independent predictor for stroke recurrence in ischemic stroke patients.

Methods: We conducted a systematic review and meta-analysis of studies on the effect of diabetes on stroke recurrence among patients with ischemic stroke. We searched population-based studies published before 15th February 2021 in PubMed and EMBASE following PRISMA guidelines. Random-effects estimates of the pooled hazard ratio (HR) and 95% confidence intervals (CIs) of each study were generated. A funnel plot and Egger test were performed to evaluate publication bias. All statistical analyses were conducted in the R software 4.0.1 and Stata 16.0.

Results The search identified 3121 citations, of which 27 studies met inclusion criteria. Diabetes was associated with a significant risk of stroke recurrence in all ischemic stroke patients (pooled HR, 1.50; 95% CI, 1.36-1.65; I2=61.0%). Similar results were found in lacunar stroke patients with diabetes (pooled HR, 1.65; 95% CI, 1.41-1.92; I2=22.0%). Moreover, we found the risk of recurrent ischemic stroke among patients of ischemic stroke with diabetes was higher than those without diabetes (pooled HR, 1.53; 95% CI, 1.30-1.81; I2=74.0%).

Conclusion Diabetes is an independent risk factor for stroke recurrence among patients with ischemic stroke.

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