Introduction: Diabetes is a well-established risk factor for stroke and other vascular disease. Consequently, diabetes management is important for prevention of primary and secondary vascular events. Hospitals offer diabetes education, but it is unknown if the appropriate patients are receiving the necessary information. The objective of this study was to determine the factors associated with receiving diabetes management teaching among patients presenting to a hospital with an ischemic stroke (ISC) or Transient Ischemic Attack (TIA) who have a concurrent new diabetes diagnosis.
Methods: Data from 20 hospitals in a multi-state healthcare system stroke registry from 2002 to May 2015 were used. ISC or TIA patients with a new, in-hospital diagnosis of diabetes were included. Patients on comfort care, transferred to an outside facility from the emergency department, discharged to hospice or expired were excluded. Associations between receiving diabetes management education and demography, insurance, medical history, BMI, functional status, and stroke severity of the patient were examined using a generalized linear mixed model with a logit link.
Results: Data from 336 newly diagnosed diabetes patients were used in the analyses. Of those, 269 (80.1%) received diabetes management education, while 67 (19.9%) did not. Patients with a medical history of drug or alcohol abuse were 79% less likely to receive diabetes management training than those without a history (adjusted odds ratio [AOR] = 0.215, p=.014). Patients who were overweight or obese weight were over three times more likely to receive diabetes management education than patients who were of normal weight or underweight (AOR = 2.92, p=.003). For every one-point increase of the NIH Stroke Scale score, the likelihood of receiving education decreased by 6% (AOR=.913, p=.005), and with each additional five years of age the likelihood of receiving education decreased by 14% (AOR=.861, p=.017). Gender, insurance type, discharge status, and medical histories of atrial fibrillation, CAD/prior MI, previous strokes, previous TIA, hypertension, family history of stroke were not significant predictors.
Conclusions: Almost 20% of patients with newly diagnosed diabetes did not receive diabetes management education. While education was appropriately targeted to overweight and obese patients, these results indicate that patients with a history of drug and alcohol abuse, those who are normal or under-weight and those with more severe strokes were underserved. More work needs to be done to ensure that stroke patients are receiving appropriate education to prevent subsequent cerebrovascular events.