Key result
SGLT2 inhibitors and GLP-1 receptor agonists were associated with a reduced risk of non-fatal stroke or TIA (HR 0.59 and 0.79, respectively) in patients with newly diagnosed type 2 diabetes.
Why the study?
Previous observational studies on glucose-lowering drugs and stroke risk in type 2 diabetes yielded conflicting results.
Do glucose-lowering drugs (specifically SGLT2 inhibitors and GLP-1 receptor agonists) reduce incident non-fatal stroke and TIA in patients with newly diagnosed type 2 diabetes?
Cohort (n=312,368)
Yes
Do glucose-lowering drugs (specifically SGLT2 inhibitors and GLP-1 receptor agonists) reduce incident non-fatal stroke and TIA in patients with newly diagnosed type 2 diabetes?
Hazard Ratio: 0.59 (95% CI 0.54–0.64)
SGLT2 inhibitors and GLP-1 receptor agonists are associated with a significantly reduced risk of incident non-fatal stroke and TIA in patients with newly diagnosed type 2 diabetes.
Associated with lower stroke/TIA risk in new T2D; extends conflicting observational data but leaves causal effects open.
Aims Previous observational studies on glucose-lowering drugs and risk of stroke in type 2 diabetes yielded conflicting results. The aim was to examine the association of glucose-lowering drugs with incident stroke and transient ischaemic attacks (TIA) in newly diagnosed type 2 diabetes. Methods We conducted a retrospective cohort analysis of the disease analyzer, which comprises a representative panel of 1248 general and internal medicine practices throughout Germany (01/2000–12/2019: 9.8 million patients). Incident non-fatal stroke/TIA was defined based on ICD-10 codes (I63, I64; G45) in newly diagnosed type 2 diabetes. Cox regression models were fitted to obtain hazard ratios (HR; 95%CI) for stroke/TIA adjusting for potential confounders (age, sex, health insurance, coronary heart disease, myocardial infarction, heart failure, polyneuropathy, blood pressure, eGFR) and anthropometric and metabolic intermediators (BMI, HbA1c, HDL- and LDL-cholesterol, triglycerides, lipid-lowering drugs). Result 312,368 persons with newly diagnosed type 2 diabetes without previous stroke/TIA (mean age: 64 years; 52% males) were included. There were 16,701 events of non-fatal stroke/TIA corresponding to an incidence rate of 9.3 (95%CI 9.1–9.4) per 1000 person-years. Using Cox regression, adjusted HR for stroke/TIA (per 1 year of treatment) of 0.59 (0.54–0.64) for SGLT2 inhibitors and of 0.79 (0.74–0.85) for GLP-1 receptor agonists were estimated. DPP-4 inhibitors (0.84; 0.82–0.86), metformin (0.90; 0.89–0.91), insulin (0.92; 0.91–0.93) and sulfonylureas (0.98; 0.96–0.99) also showed moderately reduced HR for stroke/TIA. Sex-specific regression analyses yielded similar results (HR). Conclusions Treatment with SGLT2 inhibitors or GLP-1 receptor agonists might reduce non-fatal stroke/TIA in persons with newly diagnosed type 2 diabetes.
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Rathmann et al. (2022) conducted a cohort in Type 2 diabetes (n=312,368). SGLT2 inhibitors vs. Other glucose-lowering drugs was evaluated on Incident non-fatal stroke or transient ischaemic attack (TIA) (HR 0.59, 95% CI 0.54-0.64). SGLT2 inhibitors and GLP-1 receptor agonists were associated with a reduced risk of non-fatal stroke or TIA (HR 0.59 and 0.79, respectively) in patients with newly diagnosed type 2 diabetes.
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