Stroke, also known as cerebrovascular accident (CVA), represents a major global health burden and is currently the second leading cause of death and the third leading cause of long-term disability worldwide. According to the World Health Organisation (WHO), stroke is defined as a rapidly developing clinical sign of focal or global disturbance of cerebral function, with symptoms lasting for more than 24 hours or leading to death, and with no apparent cause other than vascular origin (1). Among all cerebrovascular events, ischemic strokes account for approximately 80%, while the remaining 20% are haemorrhagic in nature (1,2).

Diabetes mellitus (DM) is a well-established, independent, and modifiable risk factor for stroke. Epidemiological evidence consistently demonstrates that individuals with diabetes have a significantly higher risk of both ischemic and haemorrhagic strokes compared to non-diabetics (3). The Emerging Risk Factors Collaboration reported adjusted hazard ratios of 2.27 for ischemic stroke, 1.56 for haemorrhagic stroke, and 1.84 for unclassified stroke among diabetic patients (4). Furthermore, diabetes frequently coexists with other cardiovascular risk factors such as hypertension, dyslipidaemia, and myocardial infarction, which collectively amplify the risk of cerebrovascular events (5). Even prediabetes, characterised by impaired fasting glucose and/or impaired glucose tolerance, has been associated with an increased risk of stroke (5).

The pathophysiology of stroke in diabetic individuals is multifactorial and involves complex mechanisms, including endothelial dysfunction, increased thrombogenesis, oxidative stress, chronic inflammation, and hypercoagulability. Diabetes promotes a prothrombotic state through elevated levels of fibrinogen and von Willebrand factor, reduced fibrinolysis due to increased plasminogen activator inhibitor-1, and accelerated atherosclerosis driven by lipid abnormalities such as hypertriglyceridemia and low high-density lipoprotein (HDL) cholesterol (6). These metabolic and vascular alterations contribute to both microvascular and macrovascular damage, resulting in an approximately two-fold increased risk of stroke in diabetic patients compared to non-diabetics (7).

Emerging evidence suggests that the clinical profile and stroke patterns in diabetic patients differ from those observed in non-diabetic individuals (8). Diabetes has been associated with a higher prevalence of ischemic strokes, particularly involving the posterior circulation (9–12). While the overall incidence of lacunar infarctions may not differ significantly, diabetic patients appear more prone to multiple lacunar infarcts (13,14). Additionally, hyperglycaemia at stroke onset has been identified as an independent predictor of increased stroke severity, morbidity, and mortality, irrespective of stroke subtype or patient age. Diabetes also confers a higher stroke risk among younger individuals and women (8,15).

Given the rapidly increasing global prevalence of diabetes and its strong association with cerebrovascular disease, a comprehensive understanding of the interplay between diabetes and stroke is imperative. Despite extensive research, uncertainties remain regarding whether diabetic patients exhibit distinct clinical presentations, stroke patterns, and prognostic outcomes compared to non-diabetic patients (1–3). Therefore, the present study aims to evaluate the clinical profile and stroke patterns in diabetic and non-diabetic patients and to examine the relationship between glycaemic control, as assessed by HbA1c levels, and stroke subtype and prognosis at a tertiary care centre. Improved understanding of these associations may aid in better risk stratification, early diagnosis, and optimized management, while reinforcing the importance of preventive strategies such as lifestyle modification and effective glycaemic control to reduce the burden of stroke in diabetic populations.

This hospital-based cross-sectional study was conducted to compare the clinical profile and severity of stroke among diabetic and non-diabetic patients. The study was carried out in the Department of General Medicine at Dr. B.R. Ambedkar Memorial Hospital (Dr. BRAMH), Raipur, a tertiary care teaching hospital catering to a large population from central India. The duration of the study was one year, during which all eligible patients admitted with acute stroke were screened for inclusion.

The study population comprised adult patients aged 18 years and above who were admitted to the medical wards with a diagnosis of acute stroke. Both diabetic and non-diabetic patients who provided informed written consent were included in the study. Patients with a prior history of stroke with residual neurological deficits were excluded. In addition, patients with acute medical conditions that could confound stroke presentation, such as sepsis, acute central nervous system infections (including meningitis and encephalitis), head trauma, or metabolic encephalopathy, were excluded.

The sample size was calculated using the formula for comparing two means, considering a 95% confidence interval and 80% power of the study. The calculation was based on the expected difference in mean National Institutes of Health Stroke Scale (NIHSS) scores between diabetic and non-diabetic patients, with standard deviations derived from previous studies and an equal allocation ratio between the two groups.

Data were collected using a structured proforma. A detailed clinical history was obtained from each patient or their attendant, including the onset and duration of stroke symptoms, associated features such as seizures, headache, vomiting, and loss of consciousness, and the presence of motor, sensory, cerebellar, autonomic, and cranial nerve involvement. Information regarding diabetes mellitus, including its presence or absence, duration, and current treatment modalities such as oral hypoglycaemic agents, insulin therapy, or lifestyle modifications, was also recorded.

A comprehensive physical examination was performed for all patients, which included assessment of vital parameters such as blood pressure, pulse rate, respiratory rate, and body temperature. A complete general and systemic examination was conducted with special emphasis on detailed neurological assessment to identify focal deficits.

Stroke severity was assessed in all patients using the National Institutes of Health Stroke Scale (NIHSS), which evaluates 11 neurological domains, including level of consciousness, motor power, sensory function, language, and visual fields. Based on the NIHSS score, stroke severity was categorized as minor (1–4), mild (5–15), moderate (16–20), or severe (≥21).

All patients underwent laboratory investigations, including haematological and biochemical tests. Haematological investigations included a complete blood count with haemoglobin, total leukocyte count, and lymphocyte count. Biochemical investigations comprised serum lipid profile, including total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides, along with serum albumin levels. Glycaemic status was assessed using fasting blood glucose and glycated haemoglobin (HbA1c) levels to confirm diabetic status and evaluate long-term glycaemic control.

Radiological evaluation was performed using non-contrast computed tomography (NCCT) of the brain in all patients to confirm the diagnosis of stroke, differentiate between ischemic and haemorrhagic stroke, and exclude stroke mimics.

The collected data were entered into a computerised database and analysed using appropriate statistical software. Patients were categorised into diabetic and non-diabetic groups for comparison. Continuous variables were expressed as mean and standard deviation, while categorical variables were presented as frequencies and percentages. Statistical comparisons between the two groups were performed using appropriate tests such as the independent t-test, chi-square test, or analysis of variance, depending on the nature and distribution of the data. A p-value of less than 0.05 was considered statistically significant.

Ethical approval for the study was obtained from the Institutional Ethics Committee prior to its initiation. Written informed consent was obtained from all participants or their legally authorized representatives. Patient confidentiality was strictly maintained, and no additional financial burden was imposed on the participants. All patients received standard treatment as per institutional protocols, and a patient information sheet explaining the purpose, methodology, and rights of the participants was provided.

Table No. 1: Patient Characteristics and Risk Factors

Table 1 presents a comparison of demographic and clinical characteristics between diabetic (n = 65) and non-diabetic (n = 35) patients admitted with acute stroke. The age distribution was similar in both groups, with the majority of patients falling within the 51–60 years age range (41.5% diabetics vs. 28.6% non-diabetics). Younger (<40 years) and older (>80 years) age groups comprised a small proportion of the study population. Statistical analysis revealed no significant difference in age distribution between the two groups (χ² = 0.518).

Gender distribution demonstrated a male predominance in both groups (52.3% diabetics vs. 60% non-diabetics), with no significant difference observed (χ² = 0.461).

Hypertension was significantly more prevalent among diabetic stroke patients (72.3%) compared to non-diabetic patients (48.6%), indicating a strong association between diabetes and elevated blood pressure in this cohort (χ² = 0.018). In contrast, the prevalence of dyslipidemia was slightly higher in diabetics (46.2%) than non-diabetics (37.1%), but the difference was not statistically significant (χ² = 0.385). Similarly, smoking was reported in 26.2% of diabetics and 22.9% of non-diabetics, with no significant difference between groups (χ² = 0.717).

In-hospital mortality rates were comparable between diabetic (12.3%) and non-diabetic (11.4%) patients, indicating that diabetes did not independently predict short-term mortality in this cohort (χ² = 0.897).

Table No. 2: Stroke Severity in Diabetic and Non-Diabetic Patients

Table 2 presents the distribution of stroke severity, assessed using the NIHSS, among diabetic and non-diabetic patients. Among diabetic patients (n = 65), the majority experienced moderate to severe strokes (38.5%), followed by moderate strokes (36.9%), severe strokes (21.5%), and only a small proportion had minor strokes (3.1%). In contrast, non-diabetic patients (n = 35) predominantly presented with moderate strokes (42.9%) and minor strokes (22.9%), with fewer cases of moderate to severe (20.0%) and severe strokes (14.3%).

The difference in stroke severity between diabetic and non-diabetic patients was statistically significant (P = 0.007), indicating that diabetes is associated with a higher likelihood of presenting with more severe strokes. Specifically, minor strokes were substantially less frequent in diabetic patients, while moderate-to-severe and severe strokes were more common compared to non-diabetic patients.

Table No. 3:  Stroke Severity in Subgroups of Diabetic and Non-Diabetic Patients

Table 3 presents the distribution of stroke severity among diabetic and non-diabetic patients stratified by hypertension, dyslipidemia, smoking, and mortality.

Hypertensive Patients: Among hypertensive diabetics (n = 47), the majority experienced moderate (40.4%) and moderate-to-severe strokes (42.6%), with fewer patients presenting with minor (2.1%) or severe strokes (14.9%). In hypertensive non-diabetics (n = 17), stroke severity was more evenly distributed, with minor strokes (17.6%), moderate (29.4%), moderate-to-severe (29.4%), and severe strokes (23.5%). The association between diabetes and stroke severity in hypertensive patients was not statistically significant (P = 0.098), though diabetics tended to have more moderate-to-severe strokes.

Dyslipidemic Patients: In dyslipidemic diabetics (n = 30), most patients had moderate (46.7%) or moderate-to-severe strokes (43.3%), with severe strokes (10%) and no minor strokes. Among dyslipidemic non-diabetics (n = 13), moderate strokes (53.8%) were most common, followed by minor (15.4%), moderate-to-severe (15.4%), and severe strokes (15.4%). The difference between groups approached but did not reach statistical significance (P = 0.073), suggesting a trend toward greater stroke severity in dyslipidemic diabetics.

Smokers: Among diabetic smokers (n = 17), the majority presented with moderate-to-severe (52.9%) and moderate strokes (35.3%), with fewer severe (11.8%) and no minor strokes. In non-diabetic smokers (n = 8), moderate strokes (50%) predominated, followed by moderate-to-severe (37.3%) and severe strokes (12.5%), with no minor strokes. The association between diabetes and stroke severity in smokers was not significant (P = 0.753).

Mortality Subgroup: Among patients who died, diabetic patients (n = 8) primarily had moderate-to-severe (50%) and moderate strokes (25%), with severe strokes (25%) and no minor strokes. Non-diabetic patients (n = 4) exhibited severe (50%), minor (25%), and moderate-to-severe strokes (25%), with no moderate strokes. The difference in stroke severity among deceased patients between diabetic and non-diabetic groups was not statistically significant (P = 0.272).

This hospital-based cross-sectional study compared the clinical profile and stroke severity between diabetic and non-diabetic patients admitted with acute stroke at Dr. B.R. Ambedkar Memorial Hospital, Raipur. A comprehensive assessment integrating clinical, laboratory, and radiological parameters was conducted within a standardized clinical framework.

Strict inclusion and exclusion criteria were applied to minimize confounding and to evaluate the independent impact of diabetes mellitus on stroke characteristics. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), a validated tool that enabled standardized classification of stroke severity and meaningful comparison between study groups.

The sample size was determined using appropriate statistical power calculations, and data were collected through a structured proforma to ensure systematic and reproducible documentation. Major vascular risk factors were evaluated using guideline-based definitions, and diabetes status was confirmed using HbA1c estimation.

All patients underwent non-contrast CT of the brain for diagnostic confirmation and stroke subtype classification. Ethical approval was obtained prior to study initiation, informed consent was secured from all participants, and patient confidentiality was maintained. Conducted at a tertiary care center in central India, this study reflects the regional burden of stroke in the context of the growing prevalence of diabetes.

The age distribution of stroke patients showed that the majority, irrespective of diabetic status, were between 51–60 years of age (37%), followed by those aged 61–70 years (25%). Among diabetic patients, 41.5% belonged to the 51–60 year age group, compared with 28.6% of non-diabetics, indicating that individuals in their sixth decade constitute a substantial proportion of diabetic stroke cases. Patients younger than 40 years accounted for only 9% of the study population, with comparable representation among diabetics (7.7%) and non-diabetics (11.4%). Those aged 71–80 years constituted 13% of cases, while patients above 80 years accounted for 2%. No statistically significant association was observed between age group and diabetic status (χ² test, p = 0.518).

In contrast, Joshi et al. (2022) reported a significant difference in age distribution between diabetic and non-diabetic stroke patients, with the highest proportion of non-diabetic patients in the 51–60 year age group and diabetic patients predominantly in the 71–80 year group (p = 0.009). Similarly, Dr. Neera Samar et al. (2023) observed that most stroke patients were aged 61–70 years, while Jain et al. (2020) reported a higher mean age among diabetic patients compared to non-diabetics (64.33 ± 10.33 vs. 60.15 ± 13.74 years), suggesting variability in age-related stroke patterns across populations.

The gender distribution in the present study demonstrated a male predominance among stroke patients in both diabetic and non-diabetic groups. Among diabetic patients, 52.3% were male and 47.7% were female, while in the non-diabetic group, males constituted 60% and females 40%. Overall, males accounted for 55% of the study population and females for 45%. The difference in gender distribution between diabetic and non-diabetic patients was not statistically significant (χ² = 0.544, p = 0.461).

These findings are consistent with previous studies. Joshi et al. (2022) also reported a higher proportion of males in both diabetic and non-diabetic stroke groups, with no significant gender-based difference. Similarly, Dr. Neera Samar et al. (2023) observed a clear male predominance, with males comprising 70% of stroke cases. Jain et al. (2020) likewise reported a higher prevalence of stroke among males, with 66.5% males and 33.5% females, reinforcing the commonly observed male preponderance in stroke populations.

In the present study, hypertension was significantly more prevalent among diabetic stroke patients (72.3%) compared with non-diabetic patients (48.6%), and this difference was statistically significant (χ² = 5.563, p = 0.018). This finding highlights the strong association between diabetes mellitus and hypertension in patients presenting with acute stroke.

Similar observations have been reported in earlier studies. Morsy et al. (2022) found a significantly higher prevalence of hypertension among diabetic stroke patients compared to non-diabetics (77% vs. 63%, p = 0.031). Likewise, Jain et al. (2020) reported hypertension in the majority of both diabetic (70 of 78) and non-diabetic (63 of 72) stroke patients, while Desilles et al. (2013) also demonstrated a significant association between diabetes and hypertension among stroke patients.

In contrast, Joshi et al. (2022) reported a higher prevalence of systemic hypertension among non-diabetic stroke patients compared to diabetic patients (89.2% vs. 30.8%, p < 0.001), indicating variability across populations and suggesting that regional and demographic factors may influence the interaction between diabetes and hypertension.

In the present study, dyslipidemia was identified in 43% of the total stroke population. Its prevalence was higher among diabetic patients (46.2%) than non-diabetic patients (37.1%); however, this difference was not statistically significant (χ² = 0.754, p = 0.385).

In contrast, Morsy et al. (2022) reported a significantly higher prevalence of dyslipidemia among diabetic stroke patients compared to non-diabetics (62% vs. 45%), indicating that the association between diabetes and dyslipidemia may vary across study populations.

In the present study, 25% of the total stroke patients were current or past smokers. Smoking was slightly more prevalent among diabetic patients (26.2%) than non-diabetic patients (22.9%); however, this difference was not statistically significant (χ² = 0.132, p = 0.717). Similar findings were reported by Dr. Neera Samar et al. (2023), in which 34 stroke patients had a history of smoking.

In the present study, in-hospital mortality was comparable between diabetic (12.3%) and non-diabetic patients (11.4%), with an overall mortality rate of 12%. The difference between the two groups was not statistically significant (χ² = 0.017, p = 0.897). In contrast, Snarska et al. (2017) reported that diabetes was associated with an increased risk of in-hospital mortality in patients with hemorrhagic stroke, but not in those with ischemic stroke.

The analysis of stroke severity revealed a statistically significant difference between diabetic and non-diabetic patients (χ² = 12.159, p = 0.007). Diabetic patients were more likely to present with moderate to severe (78.1%) and severe strokes (73.7%), whereas minor strokes were more common among non-diabetic patients (80.0%). Only 20% of minor stroke cases were diabetic, compared to 73.7% of severe stroke cases. Similar findings have been reported by Joshi et al. (2022) and Dr. Neera Samar et al. (2023), who observed higher NIHSS scores among diabetic patients (p < 0.001 and p = 0.016, respectively). In contrast, Tziomalos et al. (2014) reported comparable neurological deficits between diabetic and non-diabetic patients at admission (8.7 ± 8.8 vs. 8.6 ± 9.2; P = NS).

When assessing the relationship between age and stroke severity, the mean age of diabetic patients increased with stroke severity, from 53.5 ± 6.36 years in minor strokes to 59.04 ± 8.74 years in moderate to severe strokes, though this was not statistically significant (p = 0.870). A similar trend was observed among non-diabetic patients, with mean ages ranging from 50.88 ± 8.51 years in minor strokes to 60.40 ± 13.92 years in severe strokes (p = 0.397).

This study assessed stroke severity among hypertensive patients, comparing those with and without diabetes mellitus. Among hypertensive diabetics, 40.4% had moderate strokes, 42.6% had moderate to severe strokes, 14.9% had severe strokes, and 2.1% had minor strokes. In hypertensive non-diabetics, stroke severity was more evenly distributed: 17.6% minor, 29.4% moderate, 29.4% moderate to severe, and 23.5% severe. Despite a higher proportion of moderate to severe strokes in diabetic hypertensive patients, the association between diabetes and stroke severity was not statistically significant (p = 0.098).

Previous studies highlight the impact of hypertension on stroke severity. Sacco et al. (2004) reported hypertension as a strong predictor of both ischemic and hemorrhagic stroke severity due to chronic vascular damage, while diabetes, though an independent risk factor, was less predictive of severity in hypertensive individuals. Conversely, Sengupta et al. (2019) found that hypertensive diabetics often experience more severe strokes, likely due to combined microvascular and macrovascular complications. In line with these findings, our study suggests that while diabetes contributes to stroke occurrence and outcomes, hypertension may play a more dominant role in determining stroke severity in this cohort.

This study analyzed stroke severity among dyslipidemic patients with and without diabetes mellitus. Among diabetic dyslipidemic patients, most experienced moderate strokes (46.7%) or moderate to severe strokes (43.3%), with 10% having severe strokes and none presenting with minor strokes. In non-diabetic dyslipidemic patients, 15.4% had minor strokes, 53.8% moderate, 15.4% moderate to severe, and 15.4% severe strokes. The association between diabetes and stroke severity in dyslipidemic patients was marginally non-significant (p = 0.073).

These findings are consistent with literature indicating that dyslipidemia is a significant stroke risk factor, while diabetes exacerbates vascular dysfunction and thrombogenicity, increasing stroke severity. Sacco et al. (2004) reported that both dyslipidemia and diabetes contribute to poor vascular health and worse stroke outcomes. Conversely, Sengupta et al. (2019) found that the combination of diabetes and dyslipidemia significantly increases the risk of ischemic stroke and severe outcomes.

This study examined the influence of diabetes mellitus on stroke severity among smokers. In the diabetic smoker group, most experienced moderate strokes, with 6 individuals (35.3%) having moderate strokes and 9 (52.9%) presenting with moderate-to-severe strokes. Severe strokes were observed in 2 participants (11.8%), while none had minor strokes. Among non-diabetic smokers, 4 (50.0%) had moderate strokes, 3 (37.5%) had moderate-to-severe strokes, and 1 (12.5%) experienced a severe stroke. The Chi-square test (p = 0.753) indicated no significant association between diabetes mellitus and stroke severity in smokers.

Previous studies have highlighted that both smoking and diabetes mellitus are major risk factors for stroke. Sacco et al. (2004) reported that smoking increases the risk of ischemic stroke and worsens outcomes, especially in combination with diabetes mellitus. Conversely, Wu et al. (2011) found that while smoking and diabetes independently elevate stroke risk, their combined effect does not always result in significantly worse stroke severity compared to other risk factors, such as hypertension or dyslipidemia. Furthermore, Lee et al. (2013) suggested that the additive impact of diabetes and smoking on stroke outcomes may be more pronounced in younger individuals or those with pre-existing cardiovascular conditions, indicating that age and comorbidities can modulate this relationship.

In the present study, among deceased patients in the diabetic group, 2 (25.0%) had moderate strokes, 4 (50.0%) had moderate-to-severe strokes, and 2 (25.0%) had severe strokes, with no patients experiencing minor strokes. In the non-diabetic group, the distribution differed slightly: 1 (25.0%) had a minor stroke, none (0.0%) had a moderate stroke, 1 (25.0%) had a moderate-to-severe stroke, and 2 (50.0%) had severe strokes. The Chi-square test (p = 0.272) indicated no statistically significant difference in stroke severity between diabetic and non-diabetic patients who died.

Several studies have examined the effect of diabetes mellitus on stroke severity and mortality. Ning et al. (2018) reported that diabetes substantially increases mortality risk in stroke patients, as chronic hyperglycemia can exacerbate ischemic brain injury, leading to more severe outcomes. Conversely, in line with our findings, Boehme et al. (2017) observed that while diabetes is a stroke risk factor, it does not always result in higher mortality compared to non-diabetic patients, especially among those with well-controlled blood glucose and fewer comorbidities. In contrast, Zhou et al. (2015) found that diabetic patients experienced more severe strokes and poorer survival, largely due to accelerated atherosclerosis and heightened inflammation associated with diabetes.

This hospital-based cross-sectional study at Dr. B.R. Ambedkar Memorial Hospital, Raipur, assessed the clinical profile and stroke severity among diabetic and non-diabetic patients with acute stroke. Stroke severity was evaluated using the NIHSS, alongside comprehensive clinical, laboratory, and CT-based assessments.

Diabetic patients were more likely to experience moderate-to-severe and severe strokes than non-diabetics, highlighting the impact of diabetes on stroke severity. Hypertension was significantly more common among diabetic patients, indicating its synergistic role in stroke risk, whereas dyslipidemia and smoking did not show a significant interaction with diabetes in influencing stroke severity.

In-hospital mortality was similar between diabetic and non-diabetic patients, suggesting that while diabetes increases the likelihood of severe stroke, it does not independently predict short-term mortality. Subgroup analyses revealed that comorbidities and lifestyle factors may modulate stroke severity, though diabetes remained a key determinant.

These findings underscore the importance of early detection and management of diabetes and associated vascular risk factors to reduce stroke severity and highlight regional stroke patterns, emphasizing the need for targeted preventive strategies in central India.

1. Caplan CLR. Caplan’s stroke: A clinical approach. 3rd Edn. New York:Butterworth Heieman.1996:5-12.
2. Krishnan MN. Coronary heart disease and risk factors in India - On the brink of an epidemic? Indian Heart J. Cardiological Society of India; 2012;64(4):364–367.
3. O'Donnell MJ, Xavier D, Liu L et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376:112–123.
4. Collaboration TERF. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375:2215–2222.
5. Lee M, Saver JL, Hong KS et al. Effect of pre-diabetes on future risk of stroke: meta-analysis. Br Med J. 2012;344:e3564.
6. Patel SS (2016) Cerebrovascular complications of diabetes: alpha glucosidase inhibitor as potential therapy. Horm Metab Res 48(02):83–91
7. Sarveswaraiah J, Goyal T, Kulshrestha M “Clinical profile of stroke in diabetics and non-diabetics and it’s outcome -A cross sectional study.” International Journal Dental and Medical Sciences Research. Volume 5, Issue 2, Mar - Apr 2023 pp 721-724. DOI: 10.35629/5252-0502721724
8. Mulnier HE, Seaman HE, Raleigh VS, et al Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database. Diabetologia. 2006;49(12):2859-65. doi: 10.1007/s00125-006-0493-z.
9. Janghorbani M, Hu FB, Willett WC et al (2007) Prospective study of type 1 and type 2 diabetes and risk of stroke subtypes: the nurses’ health study. Diabetes Care. 30:1730–1735
10. Megherbi SE, Milan C, Minier D, Couvreur G, Osseby GV, Tilling K, Giroud M (2003) Association between diabetes and stroke subtype on survival and functional outcome 3 months after stroke: data from the European BIOMED Stroke Project. Stroke 34(3):688–694
11. Hyvarinen M, Tuomilehto J, Mahonen M et al (2009) Hyperglycemia and incidence of ischemic and hemorrhagic stroke-comparison between fasting and 2-hour glucose criteria. Stroke. 40:1633–1637.
12. Labovitz DL, Boden-Albala B, Hauser WA, Sacco RL (2007) Lacunar infarct or deep intracerebral hemorrhage: who gets which? The northern manhattan study. Neurology 68:606–608.
13. Arauz A, Murillo L, Cantu C et al (2003) Prospective study of single and multiple lacunar infarcts using magnetic resonance imaging: risk factors, recurrence, and outcome in 175 consecutive cases. Stroke. 34:2453–2458
14. Jackson CA, Hutchison A, Dennis MS et al (2010) Differing risk factor profiles of ischemic stroke subtypes: evidence for a distinct lacunar arteriopathy? Stroke. 41:624– 629
15. Bruno A, Biller J, Adams HP Jr, Clarke WR, et al Acute blood glucose level and outcome from ischemic stroke. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Neurology. 1999;52(2):280-4. doi: 10.1212/wnl.52.2.280
16. Joshi, Deepali & Maroof, Mohd & Joshi, Subhash & Satyawali, Vivekanand. (2022). Study of clinical profile and pattern of stroke in diabetic and non-diabetic patients in a hospital of Kumaon region. Asian Journal of Medical Sciences. 13. 111-116. 10.3126/ajms.v13i12.46668.
17. Neera samar1, Dr. Abhay Singh2, Dr. Mohit Meharda3, Dr. Rashi Rajpurohit4, Dr. Shubham Sharma5, Dr. Kailash Agarwal6, & Dr. Neha Sharma7. (2023). A Comparative Study of Clinical Profile and Outcome of Acute Ischemic Stroke with Hyperglycemia in Nondiabetic and Diabetic Patients. International Journal of Medical Science in Clinical Research and Review, 6(02), Page: 505–514. Retrieved from https://ijmscrr.in/index.php/ijmscrr/article/view/53

21. . Jain D, Chawala M, Paul BS, Mittal N, Jain A, Puri S. Profile of cerebrovascular accidents in subjects with or without type 2 diabetes mellitus in intensive care units of tertiary care centers. J Anaesthesiol Clin Pharmacol. 2020 Apr-Jun;36(2):251-254. doi: 10.4103/joacp.JOACP_181_14. Epub 2020 Jun 15. PMID: 33013043; PMCID: PMC7480310.
22. Morsy, E.Y., Rohoma, K.H., Ali, S.A.M. et al. Comparison study of clinical presentation and risk factors for cerebrovascular stroke in diabetic versus nondiabetic patients. Egypt J Intern Med 34, 78 (2022). https://doi.org/10.1186/s43162-022-00165-1
23. Desilles JP, Meseguer E, Labreuche J, Lapergue B, Sirimarco G, Gonzalez-Valcarcel J, Lavallée P, Cabrejo L, Guidoux C, Klein I, Amarenco P, Mazighi M. Diabetes mellitus, admission glucose, and outcomes after stroke thrombolysis: a registry and systematic review. Stroke. 2013 Jul;44(7):1915-23. doi: 10.1161/STROKEAHA.111.000813. Epub 2013 May 23. PMID: 23704108.
24. Snarska KK, Bachórzewska-Gajewska H, Kapica-Topczewska K, Drozdowski W, Chorąży M, Kułakowska A, Małyszko J. Hyperglycemia and diabetes have different impacts on outcome of ischemic and hemorrhagic stroke. Arch Med Sci. 2017 Feb 1;13(1):100-108. doi: 10.5114/aoms.2016.61009. Epub 2016 Jun 30. PMID: 28144261; PMCID: PMC5206364.
25. Tziomalos K, Spanou M, Bouziana SD, Papadopoulou M, Giampatzis V, Kostaki S, Dourliou V, Tsopozidi M, Savopoulos C, Hatzitolios AI. Type 2 diabetes is associated with a worse functional outcome of ischemic stroke. World J Diabetes. 2014 Dec 15;5(6):939-44. doi: 10.4239/wjd.v5.i6.939. PMID: 25512800; PMCID: PMC4265884.
26. Sacco RL, Ganzeboom KS, Selvin E, et al. Risk factors for stroke in patients with diabetes mellitus. Stroke. 2004;35(4):951–956.
27. Sengupta S, Ghosh D, Banerjee D. Hypertension and diabetes mellitus in ischemic stroke: Clinical implications and prognosis. J Clin Neurosci. 2019;62:47–53.
28. Wu S, Wang J, Liu M, et al. Diabetes mellitus and risk of stroke: a meta-analysis and systematic review. Neurology. 2011;77(3):219–227.
29. Lee J, Cho Y, Nam HS, et al. Smoking and diabetes mellitus in ischemic stroke: The Korean Stroke Registry. J Neurol Sci. 2013;330(1–2):10–14.
30. Ning M, Sun J, Zhang X, et al. Diabetes and stroke outcomes: A meta-analysis of 35 studies. Diabetes Care. 2018;41(6):1059–1066.
31. Boehme AK, Esenwa C, Elkind MSV. Stroke risk factors, genetics, and prevention. Circulation Research. 2017;120(3):472-495.
32. Zhou Y, Yang X, Wang H, et al. Impact of diabetes mellitus on stroke severity and outcomes: A systematic review and meta-analysis. Stroke. 2015;46(3):957–963.