OBJECTIVE To assess the national prevalence of and trends in achieving current guideline-recommended treatment goals and pharmacotherapies for primary and secondary prevention of stroke among U.S. adults with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS We performed serial cross-sectional analyses in 4,834 adults aged ≥45 years with T2D who participated in the 2001–2018 National Health and Nutrition Examination Survey. With stratification by stroke history, we estimated the proportion of adults with T2D who achieved current guideline-recommended strategies for stroke prevention. Preventive strategies for stroke were benchmarked against diabetes care and cardiovascular risk reduction guidelines. RESULTS Overall in 2001–2018, among those without stroke history, the proportion who achieved primary stroke prevention strategies ranged from 8.4% (95% CI 6.8–10.1) for aspirin/clopidogrel treatment in those with a higher cardiovascular disease risk to 80.5% (78.8–82.2) for nonsmoking. Among those with stroke history, the proportion who achieved secondary stroke prevention strategies ranged from 11.8% (8.7–14.8) for weight control to 80.0% (74.9–84.9) for glycemic control. From 2001 to 2018, among those without stroke history, there was a significant increase in statin therapy (Ptrend < 0.0001), smoking abstinence (Ptrend = 0.01), and ACE inhibitor/angiotensin receptor blocker treatment for hypertension (Ptrend = 0.04) but a substantial decline in weight control (Ptrend < 0.001). Among those with stroke history, only statin therapy (Ptrend = 0.01) increased significantly over time. CONCLUSIONS During 2001–2018, the achievement of some current guideline-recommended strategies for stroke prevention among U.S. adults with T2D improved but remains a challenge overall. Efforts are needed to improve implementation of strategies for stroke prevention in this population.

中文翻译：

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2001-2018 年美国 2 型糖尿病成人中风推荐策略实现的全国趋势

目的 评估美国成人 2 型糖尿病 (T2D) 中卒中一级和二级预防的当前指南推荐的治疗目标和药物治疗的全国患病率和趋势。研究设计和方法 我们对参加 2001-2018 年国家健康和营养检查调查的 4,834 名年龄≥45 岁的 T2D 成年人进行了系列横断面分析。通过按卒中史分层，我们估计了达到当前指南推荐的卒中预防策略的成人 T2D 患者的比例。中风的预防策略以糖尿病护理和降低心血管风险指南为基准。结果 总体而言，2001 年至 2018 年，在没有卒中病史的人群中，实现卒中一级预防策略的比例范围从接受阿司匹林/氯吡格雷治疗的 8.4%（95% CI 6.8-10.1）到心血管疾病风险较高人群的 80.5%（95% CI 6.8-10.1）。 78.8–82.2)（禁烟）。在有中风病史的人群中，实现中风二级预防策略的比例范围为体重控制的 11.8% (8.7–14.8) 和血糖控制的 80.0% (74.9–84.9)。2001年至2018年，在无卒中病史的患者中，他汀类药物治疗（Ptrend < 0.0001）、戒烟（Ptrend = 0.01）和ACE抑制剂/血管紧张素受体阻滞剂治疗高血压（Ptrend = 0.04）显着增加，但体重控制大幅下降（Ptrend < 0.001）。在有中风病史的患者中，只有他汀类药物治疗 (Ptrend = 0.01) 随着时间的推移显着增加。结论 2001 年至 2018 年期间，美国成人 T2D 患者中一些现行指南推荐的卒中预防策略的效果有所改善，但总体而言仍然是一个挑战。需要努力改善该人群中风预防策略的实施。