ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Clinical Diabetes
Stratified Analysis of Carotid Plaque and Intima–Media Thickness as Stroke Predictors in Type 2 Diabetes
Provisionally accepted
- 1Department of Geriatrics，puer City people‘s hospital，yunnna, puer City, China
- 2Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
- 3The Department of Neurology, Department of Geriatrics，puer City people‘s hospital，yunnna, puer City, China
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Background: Stroke represents a common macrovascular complication among individuals with type 2 diabetes (T2DM). Carotid intima-media thickness (IMT) and carotid plaque (CP) serve as key indicators of cerebrovascular pathology. However, it is still unclear whether the associations of IMT and CP with stroke vary across different diabetic patient subgroups. We aimed to investigate the associations of IMT and CP with stroke in T2DM patients and further explored the subgroup variations. Methods: In this cross-sectional study, 2,627 T2DM patients aged 32-80 years were enrolled. Baseline data including age, sex, anthropometrics, blood pressure, lipid profiles, smoking status, and medication use were collected. IMT and CP were measured by ultrasonography. Logistic regression analysis was used to evaluate their associations with stroke. Stratified and interaction analyses were performed to assess subgroup-specific variations. Results: Among 2,627 enrolled participants, 51.8% reported CP, 17.8% had increased IMT (>=0.9mm), and 7.8% reported history of stroke. Multivariate analysis demonstrated that IMT and CP were differentially associated with risk for stroke. After adjustment for confounding variables, CP showed stronger associations with stroke (OR=2.97, 95% CI: 2.04-4.33) compared to IMT. Stratified analyses showed that: (1) IMT had stronger associations with stroke in females (OR=2.33), older patients (≥60 years) and diabetes duration >10 years; (2) CP showed stronger associations with stroke in males (OR=3.44), younger patients (≤49 years), and patients with diabetes duration <5 years; (3) CP showed stronger association in smokers, while IMT had higher association with stroke in non-smokers. Conclusion: Both of the two vascular markers IMT and CP showed associations with stroke in T2DM patients; however, there were significant subgroup variations. Individualized risk assessment in diabetic patients may have important clinical implications. All these findings warranted further prospective studies to confirm the subgroup-specific associations and establish causality.
Keywords: type 2 diabetes mellitus, Intima-media thickness, carotid plaque, Stroke, Vascular risk stratification, subgroup analysis
Received: 03 Oct 2025; Accepted: 10 Nov 2025.
Copyright: © 2025 Fu, Wei and Wirtz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xianwen Wei, ynpeyywxw@sina.com
Stefan Wirtz, stefan.wirtz@uk-erlangen.de
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