Changes in the prognostic value of diabetes in patients after cerebrovascular accident during long-term follow-up: data from the REGION-M registry

Aim . To evaluate the prognostic value of type 2 diabetes (T2D) and to study the relationship between T2D and the risk of mortality at different stages of long-term outpatient follow-up in patients with cerebrovascular accidents (CVA). Material and methods . Within the registry of patients who suffered a stroke in 2012-2017, medical records and discharge summaries after the reference stroke (n=900), as well as outpatient records of patients (n=684), were analyzed. During the outpatient phase of follow-up completed in 2025 within the prospective part of the REGION-M registry, the long-term prognosis of patients after stroke was assessed and the role of type 2 diabetes as a possible prognostic factor was determined at various follow-up stages (2017-2025). The primary endpoint was all-cause death. Results . The entire outpatient phase of observation was divided into four following stages: Stage 1 (median (Me) 22 [13; 38] months) — from the reference stroke to hospital discharge (2017); Stage 2 (Me 57 [45; 71] months) — outpatient follow-up (2017-2020); Stage 3 (Me 79 [68; 95] months) — outpatient follow-up (2020-2022); Stage 4 (Me 114 [103; 128] months) — outpatient follow-up (2022-2025). The median total follow-up time was 9,5 years, during this period. In general, no significant differences in survival were found in patients depending on T2D: hazard ratio (HR) =1,24; 95% confidence interval (CI): 0,985-1,567 (p=0,067), however, Piecewise Cox Regression confirmed a significant association between T2D and the death risk in patients with a history of stroke at stages 1 and 3 of outpatient follow-up as follows: direct association at stage 1 and inverse association at stage 3 (HR=0,67, 95% CI: 0,45-0,99, p=0,044 and HR=1,70 95% CI: 1,07-2,71, p=0,026). Conclusion . In the prospective REGION-M registry part, the long-term prognosis of patients with a history of stroke was assessed at various time points. T2D has an independent negative prognostic value at certain stages of long-term follow-up of such patients.