STUDY DESIGN

Type 2 diabetes (T2D) increases the risk of ischemic and hemorrhagic stroke to over 50%.¹ If a stroke occurs in these patients, the prognosis is severe in terms of higher risk of recurrent stroke, mortality, hospital admissions, and adverse cognitive outcomes.¹ Hence, there exists a need to prevent the occurrence of an initial stroke, particularly in T2D patients.¹ At the EASD Annual Meeting 2023, Dr. Sidsel Hastrup presented the results of a nationwide population-based study conducted in Denmark, which compared the effectiveness of glucagon-like peptide-1 receptor agonist (GLP-1RA), sodium-glucose cotransporter-2 inhibitor (SGLT2i), or dipeptidyl peptidase-4 inhibitor (DPP-4i) on T2D-related outcomes.

The cohort study was conducted with data from the national registries in Denmark to investigate the risk of stroke and other outcomes in T2D patients.¹ This study recruited patients with T2D without a history of stroke and were new users of GLP-1RA, SGLT2i, or DPP-4i between 2014 and 2020.¹ A total of 19,999 GLP-1RA users, 24,702 SGLT2i users, and 41,943 DPP-4i users were included in this study.¹

The primary endpoint was the incidence of stroke, and secondary endpoints included all-cause mortality and the incidence of myocardial infarction (MI).¹ To account for the differences between the groups, the data were adjusted for age, gender, year of initiation, socio-economic factors, and other comorbidities.¹ GLP-1RA and SGLT2i can potentially lower the risk of stroke and all-cause mortality, while GLP-1RA and SGLT2i can lower the risk of MI in new users with T2D without a history of stroke.¹ GLP-1RA appeared to be the most beneficial due to its benefits on several cardiovascular and mortality outcomes.¹

FINDINGS

"GLP-1RA seems to be the best choice to protect against both stroke and MI. Wider use of GLP-1RA and SGLT2i may be beneficial in terms of preventing stroke and mortality in T2D"

^{Dr. Sidsel Hastrup
Danish Stroke Center,
Department of Neurology, Aarhus University Hospital,
Aarhus, Denmark}