Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov;59(11):1443-1451.
doi: 10.1007/s00592-022-01943-7. Epub 2022 Aug 6.

Association of glucose-lowering drugs with incident stroke and transient ischaemic attacks in primary care patients with type 2 diabetes: disease analyzer database

Wolfgang Rathmann  1 , Karel Kostev  2
Affiliations

Association of glucose-lowering drugs with incident stroke and transient ischaemic attacks in primary care patients with type 2 diabetes: disease analyzer database

Wolfgang Rathmann et al. Acta Diabetol. 2022 Nov.

Erratum in

Abstract

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.

Keywords: GLP-1 receptor agonists; SGLT2-inhibitors; Stroke; Transient ischaemic attack; Type 2 diabetes.

PubMed Disclaimer

Conflict of interest statement

WR reports the receipt of consulting fees for attending educational sessions or advisory boards run by AstraZeneca, Boehringer Ingelheim, NovoNordisk and IQVIA and institutional research grants from NovoNordisk outside of the topic of the current study. KK is an employee of IQVIA, a healthcare data science company in Germany.

Figures

Fig. 1
Fig. 1
Selection of study patients: disease analyzer database
Fig. 2
Fig. 2
Association of glucose-lowering drugs with incident stroke/TIA in newly diagnosed type 2 diabetes patients: adjusted hazard ratios per year of drug therapy (95% CI). Cox regression models; model A: adjusted for age and sex; model B: model A and confounders (health insurance, coronary heart disease, myocardial infarction, heart failure, polyneuropathy, systolic and diastolic blood pressure, eGFR); model C: model B and anthropometric and metabolic intermediators (BMI, HbA1c, HDL-cholesterol, LDL-cholesterol, triglycerides), lipid lowering drugs Model D: all glucose-lowering drugs included together in model C. Model A (n = 312,368); Model B (n = 94,007); Model C (n = 63,900); Model D (n = 63,900). Triglycerides and eGFR were ln-transformed
See this image and copyright information in PMC

References

    1. Endres M, Heuschmann PU, Laufs U, Hakim AM. Primary prevention of stroke: blood pressure, lipids, and heart failure. Eur Heart J. 2011;32(5):545–552. doi: 10.1093/eurheartj/ehq472. - DOI - PubMed
    1. Chen R, Ovbiagele B, Feng W. Diabetes and stroke: epidemiology, pathophysiology, pharmaceuticals and outcomes. Am J Med Sci. 2016;351(4):380–386. doi: 10.1016/j.amjms.2016.01.011. - DOI - PMC - PubMed
    1. Larsson SC, Scott RA, Traylor M, et al. Type 2 diabetes, glucose, insulin, BMI, and ischemic stroke subtypes: Mendelian randomization study. Neurology. 2017;89(5):454–460. doi: 10.1212/WNL.0000000000004173. - DOI - PMC - PubMed
    1. Sun H, Saeedi P, Karuranga S, et al. IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. doi: 10.1016/j.diabres.2021.109119. - DOI - PMC - PubMed
    1. Benn M, Emanuelsson F, Tybjærg-Hansen A, Nordestgaard BG. Impact of high glucose levels and glucose lowering on risk of ischaemic stroke: a Mendelian randomisation study and meta-analysis. Diabetologia. 2021;64(7):1492–1503. doi: 10.1007/s00125-021-05436-0. - DOI - PubMed

MeSH terms