Diabetes drugs and stroke risk: Intensive versus conventional glucose‐lowering strategies, and implications of recent cardiovascular outcome trials

• Published in: Diabetes, obesity & metabolism Vol. 22; no. 1; pp. 6 - 15
• Main Authors: Lim, Soo, Oh, Tae Jung, Dawson, Jesse, Sattar, Naveed
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-01-2020; Wiley Subscription Services, Inc
• Subjects: Antidiabetics; Brain Ischemia - etiology; Brain Ischemia - prevention & control; Cardiovascular Diseases - prevention & control; cardiovascular outcome trial; Cerebrovascular diseases; Clinical trials; Clinical Trials as Topic; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Dipeptidyl-peptidase IV; Glucagon; glucagon‐like peptide‐1 receptor agonist; Glucose; Glucose transporter; Humans; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Peptidase; Pioglitazone; Sodium; sodium‐glucose co‐transporter‐2 inhibitor; Stroke; Stroke - etiology; Stroke - prevention & control; Thiazolidinediones; diabetes mellitus; glucagon-like peptide-1 receptor agonist; cardiovascular outcome trial; stroke; sodium-glucose co-transporter-2 inhibitor
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.13850

People with diabetes mellitus are at higher risk of ischaemic stroke and worse outcomes thereafter. However, whether it is better to prescribe intensive glucose‐lowering treatment compared with conventional treatment in people with diabetes to prevent recurrent stroke is debated. It is also crucial to consider whether specific antidiabetic agents are more efficacious and safer than others for prevention of stroke. In this review, we provide an overview of the efficacy of intensive and conventional glucose‐lowering treatment in post‐stroke management. Our conclusion is that the overall evidence for a beneficial effect of intensive glycaemic control on risk of stroke is limited. We also discuss evidence from recent large clinical trials of thiazolidinediones and new antidiabetic medications, including dipeptidyl peptidase‐4 inhibitors, glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs), and sodium‐glucose co‐transporter‐2 inhibitors. On the basis of the findings of these trials, our conclusion is that pioglitazone and the GLP‐1RA class (other than short‐acting lixisenatide) are likely to lessen the occurrence of cerebrovascular disease (by mechanisms not dependent on glucose‐lowering per se), whereas there is no consistent evidence for other drug classes.