Diabetes mellitus und ischämischer Schlaganfall

Diabetes mellitus is one of the most common risk factors of stroke. As the duration of the disease increases, the risk also increases (after 10 years the risk triples). Even the prediabetic metabolic situation can increase the risk fivefold in younger women. In addition to an individually adapted reduction in blood glucose levels, the treatment of the accompanying risk factors, in particular hypertension, is crucial when planning therapy. Multimodal therapy reduces the risk by half. In older patients, an adjusted target value for HbA_1c (glycated hemoglobin) is essential in order not to increase mortality due to an overly strict target. Modern antidiabetic drugs such as sodium–glucose cotransporter (SGLT)-2 inhibitors or glucagon-like peptide (GLP-1) receptor agonists should also be used in high-risk patients, especially those with renal insufficiency, since in a recent meta-analysis the risk of nonfatal stroke also decreased.