Association of sodium-glucose linked transporter 2 inhibitors with functional outcomes at discharge in diabetic patients with acute ischemic stroke

ObjectiveTo investigate the association between sodium-glucose linked transporter (SGLT) 2 inhibitors use and functional outcomes at discharge in diabetic patients with acute ischemic stroke (AIS).MethodsA retrospective cohort study was conducted using data from the CASE-Ⅱ registry (NCT04487340) for patients admitted between January 2022 and November 2024. Diabetic patients with AIS were categorized as SGLT2 inhibitor users or non-users (control group). The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0-2 at discharge. Propensity score matching (PSM) was performed in a 1∶2 ratio. Multivariate logistic regression models were used to assess the association between SGLT2 inhibitor use and outcomes, adjusting for potential confounders. Stratified analyses were performed based on pre-existing diabetes versus newly diagnosed diabetes during the hospitalization.ResultsThe study included 9220 patients (mean age 67±11 years; 39.4% female), of whom 1915 (20.8%) were SGLT2 inhibitor users; after PSM there were 1912 cases user group and 3683 cases in non-user group. Before PSM, the proportion of patients with an mRS score of 0-2 at discharge was significantly higher in the SGLT2 inhibitor group than that in the control group (79.8% vs. 69.2%, P<0.01). After multivariable adjustment, SGLT2 inhibitor use remained significantly associated with higher proportion of mRS 0-2 (adjusted OR=1.24, 95%CI: 1.08-1.42, P<0.01) and mRS 0-3 (adjusted OR=1.62, 95%CI: 1.32-1.99, P<0.01) at discharge. Results were consistent after PSM. In stratified analyses, SGLT2 inhibitor use was associated with improved functional outcomes in both patients with pre-existing diabetes and those with newly diagnosed diabetes.ConclusionAmong diabetic patients with AIS, SGLT2 inhibitor use is independently associated with better functional outcomes at discharge, showing a potential benefit for short-term neurological recovery.