Can new glucose-lowering medications influence stroke risk in patients with type 2 diabetes?

This review assessed the effects of new glucose-lowering drugs on stroke risk in patients with type 2 diabetes (T2D). The study showed that glucagon-like peptide-1 receptor (GLP-1) agonists are potentially beneficial for stroke risk in patients with T2D.

Patients with diabetes are at a higher risk of developing strokes. A stroke occurs because of a blockage or rupture of a blood vessel in the brain. This causes decreased blood flow and oxygen to brain tissue with subsequent damage. Persistently high blood glucose can cause damage to blood vessels over time. This increases the possibility of strokes in patients with diabetes. These patients are at twice the risk of having a stroke compared to non-diabetics.

Recently marketed glucose-lowering drugs for patients with T2D include sodium-glucose cotransporter-2 (SGLT-2) inhibitors, GLP-1 agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors. These new glucose-lowering drugs have not been shown to cause a higher risk of major adverse cardiovascular events (MACE). They may also provide possible benefits against strokes. However, there have been no direct studies comparing the effect of SGLT-2 inhibitors, GLP-1 agonists, and DPP-4 inhibitors to placebo based on the risk of strokes in patients with T2D.

This review analyzed the results of 19 studies with 155,027 patients with T2D. 5 studies studied SGLT-2 inhibitors, 8 included GLP-1 agonists, and 6 studies used DPP-4 inhibitors. The effects of treatments on stroke risk were assessed and compared to placebo. The average follow-up period was 1.3 to 10.5 years.

There was a 15% reduction in non-fatal stroke with the use of GLP-1 agonists compared to placebo. Total stroke risk was reduced by 16% with GLP-1 agonists compared to placebo. SGLT-2 inhibitors and DPP-4 inhibitors did not significantly lower the risk of stroke compared to placebo.

The study showed that patients with T2D may benefit from a reduced risk of strokes when treated with GLP-1 agonists compared to placebo.

The study included patients with different baseline histories of stroke which may have influenced the results. It is unclear whether GLP-1 agonists can prevent or reduce the occurrence of strokes. Further studies are needed.