Comparing clinical outcomes in patients with type 2 diabetes mellitus after ischaemic stroke: Sodium–glucose cotransporter 2 inhibitors users versus non‐users. A propensity score matching National Cohort Study

Abstract Aim This nationwide cohort study evaluated the impact of sodium–glucose co‐transporter‐2 inhibitors (SGLT2i) on patients with type 2 diabetes mellitus (T2DM) after ischaemic stroke (IS), aiming to compare clinical outcomes between SGLT2i‐treated patients and those not receiving SGLT2i. Materials and Methods Utilizing Taiwan's National Health Insurance Research Database, we identified 707 patients with T2DM treated with SGLT2i and 27 514 patients not treated with SGLT2i after an IS, respectively, from 1 May 2016 to 31 December 2019. Propensity score matching was applied to balance baseline characteristics. The follow‐up period extended from the index date (3 months after the index acute IS) until the independent occurrence of the study outcomes, 6 months after discontinuation of the index drug, or the end of the study period (31 December 2020), whichever came first. Results After propensity score matching, compared with the non‐SGLT2i group ( n = 2813), the SGLT2i group ( n = 707) exhibited significantly lower recurrent IS rates (3.605% per year vs. 5.897% per year; hazard ratio: 0.55; 95% confidence interval: 0.34–0.88; p = 0.0131) and a significant reduction in all‐cause mortality (5.396% per year vs. 7.489% per year; hazard ratio: 0.58; 95% confidence interval: 0.39–0.85; p = 0.0058). No significant differences were observed in the rates of acute myocardial infarction, cardiovascular death, heart failure hospitalization, or lower limb amputation. Conclusions Our findings indicate significantly lower risks of recurrent IS and all‐cause mortality among patients with T2DM receiving SGLT2i treatment. Further studies are required to validate these results and investigate the underlying mechanisms behind the observed effects.